Association of provider communication and discharge instructions on lower readmissions.

Since the implementation of Value-Based Purchasing, hospital readmissions now effect Medicare reimbursement. This creation of a financial incentive, along with the inherent medical incentives to reduce those readmissions forces hospitals to examine their practices on the subject. Using the Donabedian model for healthcare quality, this study examined the relationship between discharge instructions and nurse/doctor communication with the patient and lower readmissions. The readmissions variable (30-day medical) along with the discharge instruction, nurse communication, and doctor communication variables came from the Centers for Medicare and Medicaid Service's Hospital Compare dataset. Zip code-level contextual variables (aggregated to the hospital service area) were used as control variables. Results suggest that while each of the independent variables of nurse communication, doctor communication, and discharge instructions were significant in predicting lower readmissions, the strongest association came from discharge instructions, while controlling for other hospital-level and contextual factors. These results call for an increased focus on patient-centeredness by making sure that the patient understands the scope and content of their discharge instructions.