Postdischarge Video Visits for Adherence to Hospital Discharge Recommendations: A Randomized Clinical Trial

Abstract

Objective: To determine whether a postdischarge video visit with patients, conducted by hospital medicine advanced practice providers, improves adherence to hospital discharge recommendations.

Patients and methods: We conducted a single-institution 2-site randomized clinical trial with 1:1 assignment to intervention vs control, with enrollment from August 10, 2020, to June 23, 2022. Hospital medicine patients discharged home or to an assisted living facility were randomized to a video visit 2-5 days postdischarge in addition to usual care (intervention) vs usual care (control). During the video visit, advanced practice providers reviewed discharge recommendations. Both intervention and control groups received telephone follow-up 3-6 days postdischarge to ascertain the primary outcome of adherence to all discharge recommendations for new and chronic medication management, self-management and action plan, and home support.

Results: Among 1190 participants (594 intervention; 596 control), the primary outcome was ascertained in 768 participants (314 intervention; 454 control). In intervention vs control, there was no difference in the proportion of participants with the primary outcome (76.7% vs 72.5%; P=.19) or in the individual domains of the primary outcome: new and chronic medication management (94.1% vs 92.8%; P=.50), self-management and action plan (76.5% vs 71.5%; P=.18), and home support (94.1% vs 94.3%; P=.94). Women receiving intervention vs control had higher adherence to recommendations (odds ratio, 1.77; 95% CI, 1.08-2.91).

Conclusion: In hospital medicine patients, a postdischarge video visit did not improve adherence to discharge recommendations. Potential gender differences in adherence require further investigation.Clinicaltrials.gov number, NCT04547803.

Figure 1

CONSORT flow diagram for Postdischarge Early Assessment with Remote video Link (PEARL) randomized clinical trial. Participants were randomized 1:1 to control group (usual care) vs intervention group (usual care + video visit 2-5 days postdischarge) to assess effect on adherence to discharge recommendations. Of 7327 non-unique participants screened, 1190 participants were randomized to control (n=596) or intervention (n=594). Some participants were screened more than once during the study period to evaluate eligibility. Participants were not enrolled for administrative reasons, for example, if discharged before obtaining consent for randomization (n=53). In the intervention group, some participants reported technology issues during the video visit and converted to a telephone call but were analyzed in the intervention group. Intervention group participants that were no-show for video visit only (n=13) attended telephone follow-up and were analyzed in the intervention group.