Cancer care at the hospital–community interface: Perspectives of patients from different cultural and ethnic groups

Objective

To examine perceptions of cancer patients from different cultural and ethnic groups regarding the quality of their care at the hospital–community interface.

Methods

Cross-sectional study of cancer patients from a large tertiary center in Israel. Patients were surveyed on the quality of their primary-care and on their transition from the hospital. Regression analyses were used to examine differences among Hebrew-, Russian-, and Arabic-speaking patients in their assessment of six primary-care domains and of their care transition process.

Results

422 patients completed the survey. Russian speakers gave the lowest and Arabic speakers the highest ratings for all primary care domains. Arabic speakers also gave higher ratings for their care transition process than the other two groups. Minority patients’ primary-care physicians were significantly more likely than Hebrew speakers’ physicians to facilitate the hospital transition process by reviewing the discharge recommendations.

Conclusions

Cancer patients from different ethnic groups differ in their primary-care experience and their perceptions of their hospital to community transition. Primary-care physicians serve as facilitators of care transitions by discussing discharge recommendations with their minority patients.

Practice implications

Reviewing the discharge recommendations with the patient at the post-discharge primary-care visit is an important contributor to high quality transitional care.     

Patients' ratings of the in-hospital discharge briefing and post-discharge primary care follow-up: The association with 30-day readmissions

ObjectiveWe examined whether patients' ratings of their in-hospital discharge briefing and their post-discharge Primary Care Physicians' (PCP) review of the discharge summary are associated with 30-day readmissions.MethodsA prospective study of 594 internal-medicine patients at a tertiary medical-center in Israel. The in-hospital baseline questionnaire included sociodemographic characteristics, physical, mental, and functional health status. Patients were surveyed by phone about the discharge and post-discharge processes. Clinical data and health-service use was retrieved from a central data-warehouse. Multivariate regressions modeled the relationship between in-hospital baseline characteristics, discharge briefing, PCP visit indicator, the PCP discharge summary review, and 30-day readmissions.ResultsThe extent of the PCPs' review of the hospital discharge summary at the post-discharge visit was rated higher than the in-hospital discharge briefing (3.46 vs. 3.17, p = 0.001) and was associated with lower odds of readmission (OR=0.35, 95% CI 0.26–0.45). The model that included this assessment performed better than the in-hospital baseline, the in-hospital discharge-briefing, and the PCP visit models (C-statistic = 0.87, compared with: 0.70, 0.81, 0.81, respectively).ConclusionsProviding extensive post-discharge explanations by PCPs serves as a significant protective factor against readmissions.Practice implicationsPCPs should be encouraged to thoroughly review the discharge summary letter with the patient.     

Male transient hip osteoporosis: are physicians at a higher risk?

Summary

Data of 17 male patients with a final diagnosis of transient osteoporosis (TO) of the hip seen at the radiology department of a university hospital over a period of 7 years were retrospectively studied. Comparison of the proportion of doctors among TO cases with that among other hip joint pathologies revealed a significant difference.

Purpose

The objective of this study is to present clinical and radiological findings of hip TO and to assess the association of the condition with patients' occupation.

Materials and methods

Data of 17 male patients with a final diagnosis of transient osteoporosis of the hip seen at the radiology department of a university hospital over a period of 7 years were retrospectively studied.

Results

The diagnosis of transient hip osteoporosis was in accordance with the published literature for clinical, imaging findings, and laboratory results. Among the 17 cases of male transient hip osteoporosis, 65% were physicians and 12% were commercial pilots. Comparison of the proportion of doctors among TO cases with that among other hip joint pathologies revealed a significant difference. Abnormal low hormone levels of testosterone and 25-cholicalciferol (vitamin D) were detected in three and two patients, respectively.

Conclusion

The preponderance of physicians among patients with transient hip osteoporosis has not been previously reported. Etiological contribution of endocrine pathology and type of occupation to the causation of transient osteoporosis merits further research.