scholarly journals 2466

2017 ◽  
Vol 1 (S1) ◽  
pp. 80-80
Author(s):  
Sarah Terry ◽  
Molly Cox ◽  
Alexandra Linley ◽  
Jilian O’Neill ◽  
Laura Dreer
Keyword(s):  
School System ◽  
Systems Of Care ◽  
School Personnel ◽  
Medical System ◽  
Return To Play ◽  
Phone Call ◽  
Phone Calls ◽  
Prolonged Recovery ◽  
Intake Session

OBJECTIVES/SPECIFIC AIMS: To characterize parent communication frequency and content between systems of care (medical, school, and sports/recreation) of concussed youth who are in prolonged recovery. METHODS/STUDY POPULATION: In this ongoing study, 16 concussed youth (average age=14.9 years, SD=1.5; 31.2% female and 68.8% male) and their parent study partner (average age=44.3 years, SD=4.3; 87.3% female and 12.5% male) have been enrolled to date from sports medicine clinics. Demographic information was obtained during the initial clinic intake session. Weekly phone calls were also conducted with the parent and child until the child was considered asymptomatic (ie, reporting no symptoms on the SCAT3), to collect data on communication with the school, sport/recreation, and medical systems throughout the recovery process. For the purpose of this study, we evaluated communication patterns of those parents who had a child in prolonged recovery (ie, symptomatic 14 d or more post-concussion injury). Communication variables included frequency (ie, number of times a parent contacted or attempted to contact a system of care) and content or topic discussed during the contact event. RESULTS/ANTICIPATED RESULTS: Of the 16 enrolled participants to date, 68.8% (n=11) experienced concussion related symptoms 14 days postinjury (M=22.2, SD=4.6) at the time of their 2 week follow-up call and were thus considered to be in prolonged recovery. Of those 11, 81.8% (n=9) of parents reported communicating with the school system at some point between the initial clinic intake session and the 2 week follow-up phone call. The frequency of communication for this period ranged between 0 and 10 instances of contact (M=2.5, SD=2.9). Of the 11 prolonged cases, 8 participants were members of sports teams. Sixty-three percent (n=5) of those parents with a child on a sports team communicated with a coach while none of the parents contacted a team athletic trainer. The frequency of communication with the coach ranged from 0 to 8 (M=1.5, SD=2.5) over the course of 2 weeks from enrollment. With regards to the medical system, the majority of parents (72.7%, n=8) communicated at least once with a medical professional during the same time period. The frequency of communication with the medical system ranged from 0 to 8 (M=2.2, SD=2.6) points of contact. Themes that arose for communicating with the school system included informing school personnel of academic accommodations prescribed by the physician, explaining absences, and concerns about missed academic work and grades. The content of communication with the sports system (ie, coach) pertained to return-to-play issues as well as progress updates on recovery. Themes for communication with the medical system were centered on scheduling appointments, attending follow-up medical appointments, and starting return-to-play protocols. DISCUSSION/SIGNIFICANCE OF IMPACT: Parents of concussed youth who were still in prolonged recovery, for the most part, appear engaged in communicating with multiple systems of care. However, a subset of parents did not participate in contact with these systems. Further discussion of these findings will highlight areas for improvement in concussion management as well as strategies parents can utilize to advocate for their child in terms of return-to-learn and recovery.

Abstract T MP103: Effect of Follow-up Phone Calls on 30-day Readmission Rates for Stroke Patients

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kelly Anderson
Keyword(s):  
Intervention Group ◽  
Signs And Symptoms ◽  
Lifestyle Changes ◽  
Phone Call ◽  
Control Group ◽  
Readmission Rates ◽  
Convenience Sample ◽  
Phone Calls ◽  
Number Of Patients

Background and Purpose: Patients who are hospitalized for a stroke or TIA go home with a great deal of information about risk factors, medications, diet and exercise, signs and symptoms of stroke and follow-up care. This information may be difficult for the patient or caregiver to understand and can be overwhelming in the face of a new life-changing event. In addition, The Centers for Medicare and Medicaid Services will start publicly reporting 30-day readmission rates beginning in 2016. The purpose of this study is to determine if follow-up phone calls with a nurse help to reduce 30 day readmission rates for patients with stroke and TIA. Methods: This study utilized a convenience sample of adult patients who were admitted for ischemic stroke, ICH, SAH or TIA from March 2013 to February 2014. Patients in the intervention group participated in a phone call seven days after discharge to assess their compliance with medications, physician appointments and lifestyle changes. The proportion of readmissions between the groups was compared with Fisher’s exact test. Results: The total number of patients enrolled in the study was 586 and there were no significant differences in demographics between the control and intervention groups. Of the 533 patients in the control group, 54 (10%) of them were readmitted, including 11 patients readmitted for elective surgical procedures. Of the 52 patients in the intervention group, 3 (5.7%) of them were readmitted before the 7-day phone call. Of the 49 patients who participated in the 7-day phone call, none of them were readmitted ( p =0.0098). Conclusions: Patients who participate in a 7-day phone call appear to benefit and are less likely to be readmitted to the hospital. Other strategies may need to be considered for patients who are at higher risk, and thus more likely to be readmitted within seven days of discharge. In addition, some providers may wish to reconsider how they schedule elective procedures for secondary stroke prevention.

Implementing Digital Technology to Transitioning a Clinical Trial to a Registry – TAILOR-PCI Digital Study: Methods/Study Design (Preprint)

2021 ◽  
Author(s):  
Robert Avram ◽  
Derek So ◽  
Erin Iturriaga ◽  
Julia Byrne ◽  
Ryan Lennon ◽  
...  
Keyword(s):  
Clinical Trial ◽  
The United States ◽  
Completion Rate ◽  
Phone Call ◽  
Consent Rate ◽  
Digital Platform ◽  
Phone Calls ◽  
Patient Reported ◽  
Research Platform

BACKGROUND TAILOR-PCI was the largest cardiovascular genotype-based randomized clinical trial (RCT) investigating whether CYP2C19 genotype-guided selection of oral P2Y12 inhibitor therapy improved ischemic outcomes after percutaneous coronary intervention (PCI). The TAILOR-PCI Digital Registry was a novel proof-of-concept study that evaluated the feasibility of extending the main RCT follow-up period using a remote digital platform. OBJECTIVE To describe patients onboarding, engagement and results of a digital registry after enrollment in a RCT. METHODS In this intervention study, previously enrolled TAILOR-PCI patients in the United States and Canada within 24 months of randomization were invited by letters containing a URL to the TAILOR-PCI Digital Registry website (http://tailorpci.eurekaplatform.org), instructing them to download the study app. Patients previously enrolled in the TAILOR-PCI study, with a smartphone, were eligible to join the Digital Registry. Those who did not respond to the letter were contacted by phone to survey reasons for non-participation and were invited again to join the study. A direct-to-patient digital research platform (the Eureka Research Platform) was used to onboard, consent and enrol patients in the Digital Registry. Patients were asked to complete health-related surveys and provide follow-up data digitally. Consent rate to the Digital Registry, duration of participation in the Digital Registry and monthly activity completion rate. The hypothesis being tested was formulated before data collection began. RESULTS After the parent trial was completed, letters were mailed to 907 eligible patients (representing 19% of total enrolled in the RCT) across 24 sites, who were within 15.6 ± 5.2 months after randomization leading to 290 unique individuals visits to the Digital Registry website. Among those invited, 110 patients (12%) consented: 45 (41%) after the letter, 37 (34%) after the 1st phone call and 28 (25%) after a 2nd call. Of the 862 who didn’t consent after the letter, 453 patients (53%) did not respond to repeated phone calls and among the 409 patients who responded, 171 (41%) declined participation stating lack of time, 128 (31%), due to lack of smartphone and 47 (11%) due to difficulty understanding what was expected of them in the study. Patients who consented were older, had less diabetes or tobacco use; a greater proportion had bachelor's degrees or higher and were more computer literate than those who did not consent. The average completion rate of the 920 available monthly electronic visits was 64.9±7.6% without a decrease in this rate throughout the study duration. There were no differences between randomization arms in any patient reported outcomes using the digital platform. CONCLUSIONS Extended follow-up after enrollment in a RCT using a digital registry is technically feasible but was limited due to inability to contact most eligible patients, lack of time or access to a smartphone. Among those enrolled, most patients completed required electronic visits. Enhanced recruitment methods, such as introduction of the digital study at the time of RCT consent, provision of smartphone and robust study support for onboarding, should be explored further. CLINICALTRIAL TAILOR-PCI (Clinicaltrials.gov: NCT01742117)

Abstract TP288: Overcoming Obstacles Making People Healthy (OOMPH): A Patient Centered Post Discharge Follow-up Program for Stroke Patients

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Jonathan Muller ◽  
Barbara Gatton ◽  
Linda Fox ◽  
Joseph A Bove ◽  
Johanna Donovan Turner ◽  
...  
Keyword(s):  
Support Groups ◽  
Medical Information ◽  
Patient Adherence ◽  
Hospital Readmissions ◽  
Phone Call ◽  
Stroke Patients ◽  
Post Discharge ◽  
Phone Calls ◽  
Stroke Support Groups

Background and Purpose: At least 12% of stroke patients are readmitted to a hospital within 30 days of discharge. We know that patients hospitalized for other conditions are less likely to be readmitted within 30 days if they are seen by their PCP shortly after discharge. However, less than a third of patients in the New York metropolitan area admitted for heart failure, heart attacks, and pneumonia see their PCP within 14 days after discharge and nearly 40% of patients do not adhere to their prescribed regimen. In the case of cerebrovascular diseases, outpatient follow-up may prevent the majority of avoidable readmissions. The purpose of this project is to identify and reduce unnecessary, unplanned hospital readmissions after stroke. Our goal is to encourage patient adherence to prescribed medication and other therapies, as well as to ensure timely follow-up with their PCP. Methods: Stroke and transient ischemic attack (TIA) patients with a disposition of either home or short-term rehabilitation are visited and offered enrollment. Participants are given a kit which includes a personalized binder (to manage essential medical information) and a 28-slot pill box. Each patient then receives 3 phone call interviews at 7, 21 and 32 days after discharge. The aim of the phone calls is to identify obstacles to compliance with treatment regimen and follow-up care. Results: From January 2015 to June 2016, 247 patients were enrolled and followed up. Within 30 days of discharge, 10% were readmitted and 50% of all readmissions occurred within the first 7 days. Of those readmitted, 19% were due to an injury from physical therapy. Data from follow-up phone calls revealed that 83% were taking all prescribed medications, 89% had completed a follow-up with any physician, 69% were using the binder, and 61% had done all three. Conclusions: While we have not enrolled enough patients to see a statistically significant reduction in readmissions, our interviews showed that weather, depression, as well as a lack of insurance, family support, and a home health aide are all determinants on how patients will follow their prescribed regimen. The results of this study have allowed us to begin implementing stroke support groups and pre-discharge follow-up appointment scheduling.

scholarly journals Migraine phenotype prolongs recovery time in traumatic brain injury (TBI)

Neurology ◽  
2018 ◽  
Vol 91 (23 Supplement 1) ◽  
pp. S17.3-S18
Author(s):  
Cynthia Bennett-Brown ◽  
Sarah Ostrowski-Delahanty ◽  
Tracy Lynn Johnson ◽  
M. Cristina Victorio ◽  
Susan K. Klein
Keyword(s):  
Recovery Time ◽  
Outpatient Visit ◽  
Office Visit ◽  
Return To Play ◽  
Behavioral Symptoms ◽  
Patients Âgés ◽  
Prolonged Recovery ◽  
Post Traumatic ◽  
Id Migraine

We proposed that children and adolescents who had headache of migraine phenotype at initial neurologic assessment after mild TBI would take longer to clear for return to play than those who did not have those headache characteristics. Additionally, we predicted that those with migraine phenotype would be more likely to have comorbid mood or cognitive symptoms, which would also contribute to prolonged recovery. To test this, we assessed all new patients for the presence or absence of migraine phenotype with the Three-Item ID migraine screener (Lipton et al. 2003) at the first outpatient visit. Over the 5 months follow up interval (October 2017–February 2018), office visit data for 121 patients (ages 0–19 years) showed that 61% presented initially with a migraine phenotype. In that interval, 48% % (N = 58) were cleared for return to play. Those with migraine phenotype headache took longer to clear (99 vs 71 days respectively, p = 0.004). Neither age nor gender made a significant impact on length of recovery when only the presence or absence of migraine phenotype alone was considered. If patients had a migraine (vs non-migraine) phenotype headache and comorbid cognitive or behavioral symptoms (38% in our sample), their time to recovery was prolonged (109 vs 74 days respectively; F (1, 56) = 7.215, p = 0.009). These data suggest that early identification of migraine phenotype in assessment of post-traumatic headache can lead to aggressive treatment of headache, thus shortening the interval of disability after TBI. Cognitive and behavioral symptoms seem to have additional impact on recovery and should be addressed and supported in rehabilitation.

scholarly journals Evaluating the Effect of Using Mobile Phone Reminders on the Adherence to Children and Young Adults With Type 1 Diabetes Attending Outreach Appointments

2019 ◽  
Vol 10 (2) ◽  
pp. 60
Author(s):  
Arsene Florent Hobabagabo ◽  
Rex Wong ◽  
Soha El-Halabi ◽  
Edison Rwagasore ◽  
Simon-Pierre Niyonsenga ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Mobile Phone ◽  
Intervention Group ◽  
Pilot Project ◽  
Phone Call ◽  
Control Group ◽  
Phone Calls ◽  
Outreach Visits

Effective management of Type 1 Diabetes Mellitus (T1DM) requires that people living with the condition attend regular clinical visits. The Rwanda Diabetes Association (RDA) asks young T1DM patients to attend quarterly outreach visits, and prior to the visits, RDA issues reminders via local radio stations. However, adherence in attending clinical appointments has remained low.Since Rwanda has a high mobile phone penetration rate, a pilot intervention study was conducted exploring the use of mobile phone call reminders and Short Message Service (SMS) messages to increase T1DM patients’ attendance of RDA’s quarterly outreach visits. The control group was exposed to only the regular radio broadcast, while the intervention group received reminder phone calls or SMS messages 72 hours prior to their appointments in addition to the regular radio broadcast.The attendance rate was significantly different between the 14 control patients and 35 intervention patients, with 23.3% (3/14) and 76.7% (27/35) attending visits, respectively (P=0.048). The results suggest that using mHealth methods (phone call/SMS reminders) can be effective in improving health outcomes, improving the adherence of T1DM patients to follow-up visits with minimal added cost. The total cost was 0.37 USD per person, compared to potential 672.40 USD for each lost treatment, indicating the intervention is cost-effective in that it minimizes loss to follow up in resource-limited settings. Further research is needed to evaluate the feasibility of scaling up the pilot project and to understand whether improved attendance is sustained long-term.

scholarly journals Atypical Repetition in Daily Conversation on Different Days for Detecting Alzheimer Disease: Evaluation of Phone-Call Data From Regular Monitoring Service

10.2196/16790 ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e16790
Author(s):  
Yasunori Yamada ◽  
Kaoru Shinkawa ◽  
Keita Shimmei
Keyword(s):  
Alzheimer Disease ◽  
Neuropsychological Tests ◽  
Phone Call ◽  
Linguistic Features ◽  
Regular Monitoring ◽  
Phone Calls ◽  
Speech Data ◽  
Monitoring Service ◽  
Specific Number

Background Identifying signs of Alzheimer disease (AD) through longitudinal and passive monitoring techniques has become increasingly important. Previous studies have succeeded in quantifying language dysfunctions and identifying AD from speech data collected during neuropsychological tests. However, whether and how we can quantify language dysfunction in daily conversation remains unexplored. Objective The objective of this study was to explore the linguistic features that can be used for differentiating AD patients from daily conversations. Methods We analyzed daily conversational data of seniors with and without AD obtained from longitudinal follow-up in a regular monitoring service (from n=15 individuals including 2 AD patients at an average follow-up period of 16.1 months; 1032 conversational data items obtained during phone calls and approximately 221 person-hours). In addition to the standard linguistic features used in previous studies on connected speech data during neuropsychological tests, we extracted novel features related to atypical repetition of words and topics reported by previous observational and descriptive studies as one of the prominent characteristics in everyday conversations of AD patients. Results When we compared the discriminative power for AD, we found that atypical repetition in two conversations on different days outperformed other linguistic features used in previous studies on speech data during neuropsychological tests. It was also a better indicator than atypical repetition in single conversations as well as that in two conversations separated by a specific number of conversations. Conclusions Our results show how linguistic features related to atypical repetition across days could be used for detecting AD from daily conversations in a passive manner by taking advantage of longitudinal data.

Treating pediatric conjunctivitis without an exam: An evaluation of outcomes and antibiotic usage

2018 ◽  
Vol 26 (1-2) ◽  
pp. 73-78 ◽  
Author(s):  
Kristine S Penza ◽  
Martha A Murray ◽  
Jane F Myers ◽  
Julie Maxson ◽  
Joseph W Furst ◽  
...  
Keyword(s):  
Retrospective Chart Review ◽  
Phone Call ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Face To Face ◽  
Phone Calls ◽  
Significant Difference ◽  
Primary Care Office ◽  
Previous Encounter

Objective The objective of this research paper is to compare antibiotic treatment, follow-up rates, and types of follow-up encounters among eVisits, phone calls, and in-person encounters for pediatric conjunctivitis. Study design A retrospective chart review of pediatric patients evaluated for conjunctivitis between May 1, 2016 and May 1, 2017, was performed. A total of 101 eVisits, 202 in-person retail clinic visits, and 202 nurse phone calls for conjunctivitis were manually reviewed for outcomes. Exclusion criteria included previous encounter for conjunctivitis in the past 14 days, treatment with an oral antibiotic at the initial encounter, or patient outside Minnesota at the time of encounter. Comparison among the three encounter types with regard to follow-up rates, follow-up encounter type within 14 days of initial evaluation, and prescribing rates was performed. Results Patients completing non-face-to-face encounters were significantly more likely to have follow-up care (34.6% and 45.5%) than those who had a face-to-face visit at the retail clinic (7.4%), p ≤ 0.0001. Patients initially evaluated by eVisit were more likely to have follow-up at the retail clinic while patients initially evaluated by phone call were more likely to have follow-up in their primary care office. Treatment rates with antibiotics were significantly higher in phone call encounters (41.6%) than in eVisits (25.7%) or face-to-face encounters (19.8%), p < 0.0001. Conclusions Non-face-to-face visits have significantly higher rates of follow-up when compared to face-to-face encounters. Antibiotic prescribing is greater with phone call triage encounters; however, there was no significant difference in antibiotic prescribing rates between eVisits and face-to-face visits. Follow-up type varied according to site of initial encounter.

Improving the follow up rate for pediatric patients (0-16 years) attending Bharatpur Eye Hospital, Bharatpur, Chitwan, Nepal: A Public Health Intervention Study (Preprint)

2021 ◽  
Author(s):  
Manisha Shrestha ◽  
Gopal Bhandari ◽  
Suresh Kumar Rathi ◽  
Anirudh Gaurang Gudlavalleti ◽  
Binod Pandey ◽  
...  
Keyword(s):  
Public Health ◽  
Pediatric Patients ◽  
Intervention Study ◽  
Public Health Intervention ◽  
Health Intervention ◽  
Phone Call ◽  
Intervention Package ◽  
Phone Calls ◽  
The Impact

BACKGROUND The follow up of pediatric patients ensures regular ocular morbidity monitoring and better treatment outcome. Bharatpur Eye Hospital (BEH) noticed that the follow up rates were low among its pediatric patients. There are several factors including lack of awareness and forgetfulness among patients may contribute in less number of follow ups. Therefore, BEH decided to find if counselling and reminders through Short Message Service (SMS) and phone calls would improve the follow up rates. OBJECTIVE This study aims to evaluate the impact of interventions like counselling and reminder SMS and phone call in improving the follow up rate of pediatric patients. METHODS This is a public health intervention study, being conducted using the mixed method. Herein all children (0-16 years) with ocular conditions requiring at least 3 follow ups in the study period will be included. Two hundred and sixty four participants will be distributed to three groups: routine standard care, counseling and reminders with SMS and phone calls. In counseling, patients will take part in 20 minute counseling session with trained counselor in each visit and information leaflets will be provided to them. In reminder SMS and phone call group, patients will receive a SMS prior to 3 days and phone call one day prior to their scheduled visits. Patient attending within ± 2days of the scheduled date will be considered compliant to follow up. The proportion of patients completing all the follow ups in each group will be assessed. Informed consent will be taken from parent and child. Univariate and multivariate analysis will be conducted. The qualitative analysis about the barriers for follow up like educational status of the parent, distance and cost for travel will be done. RESULTS The ethical approval has been obtained from Ethical Review Board of Nepal Health Research Council (ERB protocol registration number 761/2020 P). Due to COVID-19 pandemic, as of June 2021, we have been able to enroll 112 participants (40% of the sample size). CONCLUSIONS This study will reliably document not only the factors associated with follow up rate through intervention package (counseling and reminders through SMS and phone calls) but also cost effectiveness of the intervention package, which can be applied in all the departments of the hospital. CLINICALTRIAL The protocol has also been registered in ClinicalTrials.gov, (NCT04837534) on April 08, 2021

Abstract 360: A Simplified Post-Discharge Telephone Intervention To Reduce Hospital Readmission for Patients with Cardiovascular Disease.

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Gene F Kwan ◽  
Lana Kwong ◽  
Yun Hong ◽  
Abhishek Khemka ◽  
Gary Huang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Statistical Significance ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Phone Call ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Phone Calls ◽  
Administrative Assistants

Background: Readmission rates are high for patients with cardiovascular disease, particularly heart failure (HF) and acute coronary syndrome (ACS). Telephone calls by clinical staff have had mixed effects. We aim to evaluate the degree of implementation and the effect of a quality improvement initiative using a simplified post-discharge phone call by administrative assistants. Methods: Clinical data were retrospectively reviewed at a single urban public hospital. From January through October 2012 all patient discharged home from inpatient cardiology services (intervention group, n=1034 discharges) were identified. Within 7 days, administrative assistants contacted patients via telephone and queried regarding (1) medication compliance, (2) awareness of follow-up appointments and (3) if clinician contact is requested. Outcome events were defined as readmissions (for any cause) within 30 days to the same hospital and are reported as patients experiencing readmission, and total readmissions. A comparison group of all patients discharged home from inpatient cardiology services from January through October 2010 (n=746) were selected as controls (no phone calls). Categorical data were compared in a univariate fashion using the Chi Square test. Statistical significance is defined as p<.05. Results: Of the 1034 discharge events in the intervention group, 620 (60.0%) had phone calls attempted. Of those, 419 (67.6%) were directly contacted. Patients were statistically different with respect to language, ethnicity and insurance status. Of the patients called, 48 (7.7%) reported medication abnormalities, 13 (2.1%) did not understand their follow-up and 38 (6.1%) had a question for a clinician. The rates of patients experiencing events was not statistically different (132 [17.7%] vs. 156 [15.1%], OR 0.85, p=.14). Total readmissions were significantly reduced (157[21.0%] vs. 179 [17.3%], OR 0.82, p=.047). Pre-specified subgroups of ACS and HF patients showed a trend towards decreased re-admissions but were not statistically significant. Conclusion: A simplified post-discharge telephone call strategy is associated with a trend towards reduced hospital readmissions for cardiology patients. Further refinements are needed to improve program implementation.

scholarly journals Lessons Learned by Medical Students about Systems-Based Practice as Patients Transition their Care

2021 ◽  
Author(s):  
Eduard Pey ◽  
Diego Sierra ◽  
Sydney Katz ◽  
Laura Greisman ◽  
Deanna Jannat-Khah ◽  
...  
Keyword(s):  
Medical Students ◽  
Care Coordination ◽  
Care Transitions ◽  
Transitions Of Care ◽  
Phone Call ◽  
Post Discharge ◽  
Medicine Clerkship ◽  
Practice Improvement ◽  
Phone Calls

Abstract Background: One in five patients suffer an adverse event within two weeks of discharge as they transition from one healthcare setting to another. Systems-based practice is a core competency of physicians and seeks to minimize these events; however, education of trainees is inconsistent. We asked whether structured post-discharge phone calls and reflections on barriers to discharge and practice improvement can enhance students’ understanding of systems-based practice. Method: Medical students in the Internal Medicine Clerkship were assigned to perform a structured post-discharge phone call on hospitalized patients as part of a “Transitions of Care” assignment. Students reflected on issues occurring at the transition from hospitalization to discharge. We performed qualitative analysis of 90 medical student responses and identified themes and sub-themes addressing issues with care transitions. Results: Students consistently identified barriers to safe discharge including issues scheduling follow-up care, poor care coordination, and inadequate social support. The post-discharge phone calls revealed problems with patients’ understanding of their discharge diagnosis, medication-related issues and patients’ failure to attend scheduled follow-up. Common student-proposed practice improvement interventions included: enhanced provider-patient communication and education, improved interdisciplinary collaboration and care coordination, and greater attention to patient’s psychosocial and financial status. Conclusions: Medical students learned about systems-based practice from a transitions of care assignment involving a post-discharge phone call, identifying critical events in over half of patients identified. Self-reflective practice within the context of direct patient care offers insights into practice improvement in care transitions.

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