L. Li2, B. W. Trautner1,2, B. A. Campbell1, L. I. Herman1, V. Poppelaars1, D. H. Berger1,2, D. Anaya1,2, S. S. Awad1,2, A. Naik1,2 1Michael E. DeBakey VA Medical Center,Houston HSR&D COIN IQUEST,Houston, TX, USA 2Baylor College Of Medicine,Houston, TX, USA
Introduction: Approximately 16% of major bowel surgeries result in a re-hospitalization. Many of these re-hospitalizations are preventable if warning signs are brought to the attention of physicians at an early stage. A patient-friendly set of discharge instructions, or an after hospital care plan (AHCP), can provide a common language for patients and providers to recognize and communicate about the warning signs in a timely manner. Our purpose was to perform qualitative analysis of patient interviews concerning two components of our AHCP, the warning signs (WS; Figure 1A) and the everyday care instructions (ECI; Figure 1B) to determine whether our materials were communicating the intended information effectively.
Methods: We had previously developed the WS and ECI content with a panel of domain experts. An iterative design approach was used to develop the single-page color format for each document. We then conducted a series of semi-structured interviews with 7 patients who had undergone colorectal surgery within the 2 prior weeks. Six research personnel performed a thematic analysis of interview transcripts through card sorting. Cluster analysis of themes used the “Jaccard Index” as a metric of distance. Patient response themes were derived from the “clusters” of patient responses (using a 0.33 distance threshold) identified by the research personnel.
Results:
Warning Signs: Patients first noticed the colors, warning signs, and heading. Patients understood that the green zone indicated “that everything is going well,” the yellow zone indicated “things you need to look out for,” and that the red zone indicated that a doctor needed to be seen right away. Patients rated the clarity of the information on this page, from 1 (lower) to 5 (higher), at an average of 4.7 (SD=0.5).
Everyday Care Instructions: The thematic analysis of patient responses to our open-ended questioning about the ECI page revealed that patients first noticed the instructions, and heading. Patients understood that the information on this page indicated that patients need to “Get moving” and that they needed to “Keep up with it.” Patients rated the clarity of the information on this page, from 1 (lower) to 5 (higher), at an average of 5.0.
Conclusion: The patient interviews and thematic analysis indicate that colorectal surgery patients understand the information provided and approve of the manner in which it is presented in the AHCP. Thus, the AHCP has the potential to help reduce preventable hospital readmissions following colorectal surgery through improving early recognition of and attention to early warning signs.
