Frequency of New or Worsening Symptoms in the Posthospitalization Period Kenneth Epstein, MD 1,2 Esther Juarez, DrPH 1 Kathy Loya 1 Mary Jo Gorman, MD 3 Adam Singer, MD 1 1 IPC—The Hospitalist Company, North Hollywood, California 2 Division of Internal Medicine, Department of Medicine, University of Colorado School of Medi- cine, Denver, Colorado 3 Advanced ICU Care, Inc. The authors thank Rahul M. Dodhia for his assis- tance in the statistical analysis of the data and Sunil Kripalani for his thoughtful review of the manuscript. Data collection, analysis, and authors’ salaries were all paid for by IPC—The Hospitalist Com- pany. This abstract was initially presented at the Society of Hospital Medicine annual meeting in April 2004 and was published as part of the proceedings of that meeting. The abstract results also have been reported in several hospitalist-related publications. BACKGROUND: When patients are discharged from the hospital, they are assumed to be stable until follow-up as outpatients. OBJECTIVE: To study the frequency of new or worsening symptoms within 2-5 days of hospital discharge. DESIGN: Retrospective analysis of data from telephone calls to patients by central- ized call center. SETTING: Patients discharged by hospitalists employed by IPC—The Hospitalist Company. PATIENTS: 15,767 patients surveyed between May 1, 2003, and October 31, 2003. INTERVENTION: Patients discharged home were contacted by a central call center in the first several days after discharge. MEASUREMENTS: Patient demographics, self-rated health status, prevalence of new or worsening symptoms, medication issues, home health services issues, and status of scheduled follow-up appointments. RESULTS: Of the patients surveyed, 11.9% reported new or worsening symptoms since leaving the hospital. There were no differences by age. Women were more likely than men to be symptomatic. Patients with worse health status were more likely to have new or worse symptoms (P  .0001). Symptomatic patients were minimally more likely to have made a follow-up appointment (61.0% vs. 58.4%, P  .05) and were more likely to have medication issues (22.2% vs. 6.8%, P  .0001) and problems with receiving home health care services (5.8% vs. 3.6%, P  .05). CONCLUSIONS: A significant percentage of patients had new or worsening symptoms in the first several days after discharge. These patients were only minimally more likely to have made follow-up appointments. A system to manage the postdischarge tran- sition period is essential to improving posthospitalization outcomes. Journal of Hos- pital Medicine 2007;2:58 – 68. © 2007 Society of Hospital Medicine. KEYWORDS: quality improvement, hospitalist medicine, transition of care, discharge management. T he Institute of Medicine reports “To Err is Human” and “Cross- ing the Quality Chasm” have drawn great attention to quality improvement and patient safety in the hospital setting. 1–3 With the growth of the hospitalist field over the past several years, 4 there has been increasing discussion about the importance of assuring quality of care, and some have argued that improving health care quality and reducing avoidable errors may be among the hospi- talist’s most important functions. 5 Most discussions about the quality of hospital care have concerned the inpatient stay itself. However, the growth of hospital medicine, with its inherent dis- continuity between inpatient and outpatient physicians, has in- tensified interest in the transition period from hospital discharge until first outpatient appointment. ORIGINAL RESEARCH © 2007 Society of Hospital Medicine DOI 10.1002/jhm.170 Published online in Wiley InterScience (www.interscience.wiley.com). 58