Information Transfer and the Hospital Discharge Summary: National Primary Care Provider Perspectives of Challenges and Opportunities

Paul M. Robelia; Deanne T. Kashiwagi; Sarah M. Jenkins; James S. Newman; Atsushi Sorita

doi:10.3122/jabfm.2017.06.170194

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Figure 1.
Discharge summary information inclusion and perceived importance. HDS, Hospital Discharge Summary.

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Table 1.

Self-Reported Primary Care Provider Practice Characteristics and Summary Findings

	No. (%)^*
Use electronic medical records
N	471
Yes	436 (93)
No	35 (7)
Frequency of having direct access to inpatient data
N	463
0% to 20% of the time	98 (21)
21% to 40%	40 (9)
41% to 60%	55 (12)
61% to 80%	96 (21)
81% to 100%	174 (38)
Frequency that hospital discharge summary is available at followup
N	466
0% to 20% of the time	63 (13.5%)
21% to 40% of the time	65 (13.9%)
41% to 60% of the time	84 (18.0%)
61% to 80% of the time	109 (23.4%)
81% to 100% of the time	145 (31.1%)
Frequency that hospital discharge summary contains all information needed
N	464
0% to 20% of the time	59 (12.7%)
21% to 40% of the time	64 (13.8%)
41% to 60% of the time	89 (19.2%)
61% to 80% of the time	136 (29.3%)
81% to 100% of the time	116 (25.0%)
Percentage of time spent on outpatient primary care
N	471
Never	9 (2)
1% to 25% of the time	18 (4)
26% to 50% of the time	29 (6)
51% to 75% of the time	59 (13)
76% to 100% of the time	356 (76)
Percentage of time spent on inpatient care
N	465
Never	263 (57)
1% to 25% of the time	159 (34)
26% to 50% of the time	29 (6)
51% to 75% of the time	6 (1)
76% to 100% of the time	8 (2)
Time in practice (years)
N	473
0 to 5	2 (0)
6 to 10	21 (4)
11 to 15	78 (16)
16 to 20	101 (21)
21 to 25	74 (16)
26 to 30	77 (16)
>30	120 (25)
Practice community size
N	471
<5000 people	32 (7)
5 to 20,000	80 (17)
20 to 50,000	73 (15)
50 to 100,000	74 (16)
100 to 500,000	116 (25)
>500,000	96 (20)
Practice setting (multiple choice)
N	474
Solo practice	79 (17)
Single specialty group	130 (27)
Multispecialty group	85 (18)
Community clinic	31 (7)
Hospital-owned clinic	89 (19)
Hospital inpatient	6 (1)
HMO	21 (4)
Academic	41 (9)
Other	57 (12)

↵* The number of total responses is different by question due to missing data.
HMO, Health Maintenance Organization.

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Table 2.

Availability of Hospital Discharge Summary (HDS) by Key Characteristics (Row Percentages Shown)

	Availability of HDS			P-Value^*	P-Value^{^†}
	0% to 40% of the Time (N = 128)	41% to 80% of the Time (N = 193)	81% to 100% of the Time (N = 145)	P-Value^*	P-Value^{^†}
Direct access to inpatient data				<.0001	<.0001
0% to 40% of the time	91 (65.9%)	40 (29.0%)	7 (5.1%)
41% to 80% of the time	30 (19.9%)	109 (72.2%)	12 (7.9%)
81% to 100% of the time	5 (2.9%)	43 (24.7%)	126 (72.4%)
Community size				.79	.15
≤20,000	34 (30.6%)	39 (35.1%)	38 (34.2%)
20,001 to 100,000	40 (27.8%)	60 (41.7%)	44 (30.6%)
100,001 to 500,000	30 (26.1%)	53 (46.1%)	32 (27.8%)
>500,000	24 (25.5%)	39 (41.5%)	31 (33.0%)
Practice type
Solo				.0003	.58
No	92 (23.8%)	166 (42.9%)	129 (33.3%)
Yes	36 (45.6%)	27 (34.2%)	16 (20.3%)
Single-specialty group				.28	.68
No	87 (25.8%)	139 (41.2%)	111 (32.9%)
Yes	41 (31.8%)	54 (41.9%)	34 (26.4%)
Multi-specialty group				.007	.82
No	115 (30.2%)	157 (41.2%)	109 (28.6%)
Yes	13 (15.3%)	36 (42.4%)	36 (42.4%)
Hospital-owned office-based				.049	.73
No	112 (29.7%)	155 (41.1%)	110 (29.2%)
Yes	16 (18.0%)	38 (42.7%)	35 (39.3%)
Academic				.09	.02^{^§}
No	117 (27.5%)	182 (42.7%)	127 (29.8%)
Yes	11 (27.5%)	11 (27.5%)	18 (45.0%)
Other^{^‡}				.23	.56
No	102 (27.9%)	144 (39.5%)	119 (32.6%)
Yes	26 (25.7%)	49 (48.5%)	26 (25.7%)

↵* Unadjusted P-value (χ² test).
↵† Adjusted P-value from nominal logistic regression model including all predictors listed in this table.
↵‡ Community clinic, hospital inpatient, group staff HMO, or other.
↵§ When stratified according to direct access to inpatient data, there is slightly less availability of the HDS among those in academic settings (see Table 3).
HMO, Health Maintenance Organization.

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Table 3.

Hospital Discharge Summary (HDS) Availability in Academic Versus Non-Academic Settings

Availability of HDS	Direct Access to Inpatient Data
	0% to 40%		41% to 80%		81% to 100%
	Non-academic	Academic	Non-academic	Academic	Non-academic	Academic
0% to 40% of the time	85 (64%)	6 (100%)	26 (18%)	4 (50%)	4 (3%)	1 (4%)
41% to 80% of the time	40 (30%)		105 (73%)	4 (50%)	36 (24%)	7 (27%)
81% to 100% of the time	7 (5%)		12 (8%)		108 (73%)	18 (69%)
Total (N)	132 (100%)	6 (100%)	143 (100%)	8 (100%)	148 (100%)	26 (100%)