Patients who transition from hospital to skilled nursing facilities frequently require home healthcare services upon discharge to home. Medicare requires a physician-signed face-to-face (F2F) form. In an academic-medical setting, non-physician providers (NPP) prepared an electronic discharge summary and incorporated the F2F into the summary, which was routed to physician for signature. This process was started in October 2016. Patients who discharged two years prior to the change (pre-group) and two years after the change (post-group) were reviewed to determine if the change improved the time to start of care of home care services. Total number of patients who discharged during this period was 382. Also reviewed was 30-day and 60-day emergency room visits and rehospitalizations for these patients.
Results of this study did not show statistically significant difference in time to start of home care services in comparing the pre- and post-groups, but, however, did show the odds of being re-hospitalized within 30 days was 57% lower among the post-implementation group. Similarly, the odds of having an ED visit within 30 days were 60% lower among this same group. Factors that can contribute to this association are standardization of the discharge process among NPPs, increased emphasis on the discharge summary itself as a handoff communication tool and increased comfort in the referral process.