Plan of Care Visits: Implementation During Hospitalization and Association With 30-Day Readmissions in a Large, Integrated Health Care System

Steven P Masiano; Susannah Rose; Judith Wolfe; Nancy M Albert; Alex Milinovich; Leslie Jurecko; Beri Ridgeway; Michael W Kattan; Anita D Misra-Hebert

doi:10.1097/MLR.0000000000002081

Plan of Care Visits: Implementation During Hospitalization and Association With 30-Day Readmissions in a Large, Integrated Health Care System

Med Care. 2024 Oct 17. doi: 10.1097/MLR.0000000000002081. Online ahead of print.

Authors

Steven P Masiano^{1

2}, Susannah Rose^{3

4}, Judith Wolfe^{5

6}, Nancy M Albert^{7

8}, Alex Milinovich², Leslie Jurecko⁹, Beri Ridgeway¹⁰, Michael W Kattan², Anita D Misra-Hebert^{1

2

11}

Affiliations

¹ Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH.
² Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH.
³ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
⁴ Center for Biomedical Ethics and Society, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.
⁵ University Hospitals St. John Medical Center, Westlake, OH.
⁶ Center for Emergency Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
⁷ Zelony Nursing Institute, Cleveland Clinic, Cleveland, OH.
⁸ Linda H. Kaufman Center for Heart Failure Treatment and Recovery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH.
⁹ Safety, Quality, and Patient Experience, Clinical Transformation Office, Cleveland Clinic, Cleveland, OH.
¹⁰ Obstetrics and Gynecology Institute, Cleveland Clinic, Cleveland, OH.
¹¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.

PMID: 39419822
DOI: 10.1097/MLR.0000000000002081

Abstract

Background: Plan of Care of Visits (POCV), including the patient, nurse, and hospital provider were implemented across an integrated health system to improve provider-patient communication during hospitalization and patient outcomes.

Objectives: To assess POCV adoption after implementation, patient characteristics assosites were classified as teachsites were classified as teachsites were classified as teachsites were classified as ciated with POCV completion, and association of POCV with 30-day readmissions.

Methods: This retrospective cohort study utilized electronic medical record (EMR) data of 237,430 adult patients discharged to home from 11 hospitals from January 2020 to December 2022. POCV completion was a discrete EMR variable. POCV adoption was estimated monthly by hospital as proportion of patients with at least 1 POCV during hospitalization, with variation among hospitals measured using the Variance Partition Coefficient (VPC). Multivariable logistic regressions assessed factors associated with POCV completion and POCV association with 30-day readmission.

Results: POCV adoption increased from 69% to 94% (2020-2022) and varied by 50% across hospitals (VPC 0.50, 95% CI: 0.29-0.70). Odds of a discharge-day POCV were lower among older patients (≥65 vs. 18-34 y, OR 0.81, CI: 0.79-0.83), and higher among female (OR 1.06; CI: 1.04-1.07), Asian (vs. White, OR 1.13; CI: 1.06-1.21), Hispanic (OR 1.09; CI: 1.05-1.13), and surgical patients (vs. medical, OR 1.33; CI: 1.30-1.35). Patients completing discharge-day POCV had lower 30-day readmission odds (2022 OR 0.76, CI: 0.73-0.79). Patients with POCV on ≥75% of hospital days had similar readmission odds trends.

Conclusions: POCV implementation was successful, and POCV completion was associated with fewer 30-day readmissions. Future work should focus on increasing POCV adoption while reducing hospital variation.