News Release

Hospital ‘T.L.C.’ linked to heart attack recovery

Peer-Reviewed Publication

Center for Advancing Health

It isn't just the quality of medical care that determines whether a patient hospitalized for a heart attack has a better long-term recovery. A new study links a good outcome to the total hospital experience, including doctor-patient communication, emotional support and discharge planning.

Despite the conventional wisdom that providing the right medications and performing medical procedures correctly are sufficient to ensuring a good outcome after a heart attack, the study appearing in the December issue of the Journal of General Internal Medicine, found that nontechnical aspects of hospital care are important as well.

Twelve months after leaving the hospital, heart attack patients who had a worse inpatient experience were more apt to report they had chest pain and shortness of breath than those patients who had better hospital care, says lead author Allen M. Fremont, M.D., Ph.D., of RAND Health in Santa Monica.

Working at Harvard Medical School, Fremont and colleagues surveyed more than 1,300 heart attack patients after they had been discharged from the hospital. Patients were asked a series of questions about aspects of care known to be important to patients and their families including whether their preferences were respected and family and friends were kept in the loop; whether they received emotional support, adequate pain control and sufficient information and education about their condition and whether care from their various hospital providers was well coordinated.

Patients who reported the most problems with these aspects of care were considered to have had a worse hospital experience than other patients. When surveyed one month after discharge, patients who had a worse hospital experience were in poorer health compared with those who had better care. Their health remained comparatively poorer when they were surveyed 12 months after discharge, even when their initial health and other factors were taken into account.

However, patients who had worse hospital care but good follow-up experiences with their outpatient physicians and other providers reported better health at 12 months. They were about as likely to have chest pain at one year as the patients who had a better hospital experience and better follow-up care.

“While a negative experience … is associated with worse long-term outcomes, this association may be offset by more positive experiences with subsequent ambulatory care,” Fremont says.

“Although hospitals and health plans frequently collect patients’ reports about care, such information is often viewed solely as an indicator of patient satisfaction rather than as a measure of quality of care that is relevant to medical outcomes,” Fremont says. “Such a view may underestimate the potential impact of patients’ experiences with care on their outcomes.”

The study was funded by the Foundation for Healthy Communities, a voluntary partnership of hospitals, physicians, home care agencies and health plans in northern New England.

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The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.

Posted by the Center for the Advancement of Health . For more research news and information, go to our special section devoted to health and behavior in the “Peer-Reviewed Journals” area of Eurekalert!, http://www.eurekalert.org/jrnls/cfah/. For information about the Center, call Ira Allen, iallen@cfah.org (202) 387-2829.


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