Enhancing Patient Understanding of Hospitalization and Post-Discharge Needs: The Impact of Physician-Led Verbal Communication and Teach-Back Method.

Abstract

Safe transitions of care post inpatient hospitalization require robust communication practices during the discharge process to ensure patient understanding. To determine if physician-led patient communication, inclusive of written and verbal instructions with the teach-back method, improves patient understanding of hospitalization and post-discharge needs. This pre-post study was piloted at an urban, 600-bed, academic tertiary care hospital over a 3-month period. Study participants included adult patients admitted to the hospitalist medical teaching service (MTS). Study participants received both a written summary and verbal instruction reinforced with teach-back method. The instruction included the four core domains of patient education: reason for admission, inpatient management, medication changes, and follow-up plan. Changes in mean patient understandings scores from pre- to post-intervention were evaluated on a 3-point scale (no, partial, or full understanding) in addition to basic demographics, level of schooling, and primary language spoken to better ascertain the drivers of improved health literacy. Among 120 study participants, mean survey scores in all four testing domains showed improvement in patient understanding of "admitting diagnosis" (21.5%, 95% CI, 0.21 to 0.40; P < 0.0001), "treatment undergone" (35.1%, 95% CI, 0.34 to 0.58; P < 0.0001), "medication changes" (45.8%, 95% CI, 0.40 to 0.67; P < 0.0001), and "discharge follow-up" (38.1%, 95% CI, 0.39 to 0.63; P < 0.0001). Mean scores improved more in patients with lower levels of schooling in all testing domains, except for "understanding of medication changes," showing more improvement in patients with high education achievement (95% CI, 0.08 to 1.09; P = 0.027). While standard discharge practice involves only a printed discharge packet, the use of a written summary of instructions and verbal reinforcement using teach-back methods improves patient understanding and health literacy of post-discharge needs during transitions of care.