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Acad Pediatr. 2015 Jan-Feb;15(1):61-8. doi: 10.1016/j.acap.2014.07.004. Epub 2014 Nov 14.

Pediatric primary care providers' perspectives regarding hospital discharge communication: a mixed methods analysis.

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Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, Mass. Electronic address:
Division of Pediatric Hospital Medicine, Department of Pediatrics, John A Burns School of Medicine, Honolulu, Hi.
Division of Pediatric Hospital Medicine, Department of Pediatrics, Barbara Bush Children's Hospital at Maine Medical Center, Portland, Me.
University of Arizona College of Medicine-Phoenix, Phoenix Children's Hospital, Phoenix, Ariz.
Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, Calif.
Dell Children's Medical Center of Central Texas, Austin, Tex.
Michigan State University College of Osteopathic Medicine, East Lansing, Mich.
Drexel University College of Medicine, St. Christopher's Hospital for Children, Philadelphia, Pa.
Warren Alpert Medical School of Brown University, Hasbro Children's Hospital, Providence, RI.



Effective communication between inpatient and outpatient providers may mitigate risks of adverse events associated with hospital discharge. However, there is an absence of pediatric literature defining effective discharge communication strategies at both freestanding children's hospitals and general hospitals. The objectives of this study were to assess associations between pediatric primary care providers' (PCPs) reported receipt of discharge communication and referral hospital type, and to describe PCPs' perspectives regarding effective discharge communication and areas for improvement.


We administered a questionnaire to PCPs referring to 16 pediatric hospital medicine programs nationally. Multivariable models were developed to assess associations between referral hospital type and receipt and completeness of discharge communication. Open-ended questions asked respondents to describe effective strategies and areas requiring improvement regarding discharge communication. Conventional qualitative content analysis was performed to identify emergent themes.


Responses were received from 201 PCPs, for a response rate of 63%. Although there were no differences between referral hospital type and PCP-reported receipt of discharge communication (relative risk 1.61, 95% confidence interval 0.97-2.67), PCPs referring to general hospitals more frequently reported completeness of discharge communication relative to those referring to freestanding children's hospitals (relative risk 1.78, 95% confidence interval 1.26-2.51). Analysis of free text responses yielded 4 major themes: 1) structured discharge communication, 2) direct personal communication, 3) reliability and timeliness of communication, and 4) communication for effective postdischarge care.


This study highlights potential differences in the experiences of PCPs referring to general hospitals and freestanding children's hospitals, and presents valuable contextual data for future quality improvement initiatives.


children; collaborative; discharge communication; medical home; transitions of care

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