Are we teaching our hospitalized patients self-management skills? Opportunities lost

Abstract

Background: In the U.S., 20% of medical hospital discharges are readmitted within 30 days. Non-medical intervention strategies, such as teaching four specific self-management skills, have demonstrated reduction in readmission risk by a third or more. Objective: To investigate whether hospitalized patients are taught or learn four basic self-management skills (“four skills”) during routine clinical encounters.
Methods: Design: Observational study from May to October 2012 in an academic teaching hospital. Participants: Consenting medical patients (aged 18 or over), their visitors or caregivers and their providers. Unit managers identified patients who would be discharged home and capable of learning the four skills. Interventions: A trained observer consented patients and monitored every provider encounter for mentioning and/or teaching of the four specific self-management skills’ content for intervals of up to 6 hours during daytime shifts. After each encounter, the observer queried the patient and their caregiver to see what information relating to the four skills they retained and understood. Additionally, observers recorded patient demographics, native language, provider type, and major medical conditions present at the time of the encounter. Five control activities expected to occur routinely for each encounter were monitored for comparison. Main measures: Frequency of one of four self-management skill education events during patient-provider encounters.
Results: We observed 56 patients over 326 encounters involving 117 physicians or medical students, 134 nurses or nursing students, and 163 hospital staff. Among 189 encounters with clinical staff (physicians or nurses), the four basic self-management skills were mentioned in 54 encounters (28.6%) but taught only in 12 encounters (6.3%). The comparison with control behaviors show a much higher proportion (hand washing 35%-41.3%, identified role 29.5%, asking for more question 19.1%). Physicians are more likely than nurses to discuss clinical conditions, medications, or any of the four skills’ topics. Specific self-management teaching of patients led to better understanding of the these skills compared to just mentioning them (p = .03).
Conclusions: Hospital providers rarely teach four basic self-management skills as part of regular care. Patients can learn this content while hospitalized which could potentially reduce 30-day readmission risk.