Using post-discharge home visitation to improve cultural sensitivity and patient-centered discharge planning by internal medicine trainees

Background. Patient-centered discharge planning improves transitional care and health outcomes for vulnerable adults. The HOME Initiative was an educational intervention aiming to improve trainees’ patient-centered discharge planning skills. Methods. Using a quasi-experimental design, 52 internal medicine residents at an academic medical center were randomized to intervention or control in 2014–2015. Intervention interns visited recently discharged patients during inpatient rotations. Interns addressed patient deficits in understanding, rectified medication errors, and provided health education. Results. Over three-quarters (77%) of intervention interns completed pre- and post-tests. Intervention interns reported significant improvements in patient-centered discharge planning skills and delivery of culturally sensitive care. Through improved communication skills, residents more effectively elicited patients’ illness narratives and assessed their patients’ safety (0.65; p=.05), functional status (0.79; p=.02) and health literacy (0.70; p=.01). Conclusion. Structured home visitation with recently discharged patients is a valuable tool for medical residents to learn patient-centered discharge planning and improve delivery of culturally sensitive care.