Original Study| Volume 22, ISSUE 11, P2344-2349, November 2021

A Cross-Sectional Survey of Internal Medicine Residents’ Knowledge, Attitudes, and Current Practices Regarding Patient Transitions to Post-Acute Care



      Prior studies have found suboptimal knowledge about post-acute care (PAC) among inpatient providers and poor communication at discharge that can lead to unsafe discharge transitions, but little is known about residents and the PAC transition. The aim of this study is to assess internal medicine residents’ knowledge, attitudes, and current practice regarding patient transitions to PAC.


      A multisite, cross-sectional 36-question survey.

      Setting and Participants

      Internal Medicine and Medicine-Pediatrics residents at 3 university-based Internal Medicine training programs in the United States. Methods: Survey delivered electronically to residents in 2018 and 2019. Survey responses were described by collapsing 4-point Likert responses into dichotomous variables, and thematic content analysis was used to evaluate free text responses. Results: Of 482 residents surveyed, 236 responded (49%). Despite high reported confidence in their ability to transition patients to PAC, only 31% of residents knew how often patients received skilled therapies at skilled nursing facilities (SNFs) and 23% knew how frequently nursing services are provided. The majority of residents (79%) identified the discharge summary as the main way they communicated care instructions to the SNF, but only 55% reported always completing it prior to discharge. Upper-level residents were more likely to know how much therapy patients received at a SNF, but resident knowledge about PAC did not vary by residency year in other domains. Residents who experienced a clinical rotation at a SNF had higher levels of knowledge compared to residents who did not.


      This national survey of internal medicine residents identified common knowledge gaps regarding PAC. These knowledge gaps did not improve throughout residency without deliberate exposure to PAC environments. This suggests a need for dedicated curriculum development as discharges to PAC continue to rise exponentially.


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        • Burke R.E.
        • Juarez-Colunga E.
        • Levy C.
        • et al.
        Rise of post-acute care facilities as a discharge destination of US hospitalizations.
        JAMA Intern Med. 2015; 175: 295-296
        • Burke R.E.
        • Juarez-Colunga E.
        • Levy C.
        • et al.
        Patient and hospitalization characteristics associated with increased postacute care facility discharges from US hospitals.
        Med Care. 2015; 53: 492-500
        • Werner R.M.
        • Konetzka R.T.
        Trends in post-acute care use among Medicare beneficiaries: 2000 to 2015.
        JAMA. 2018; 319: 1616
        • Mor V.
        • Intrator O.
        • Feng Z.
        • Grabowski D.C.
        The revolving door of rehospitalization from skilled nursing facilities.
        Health Aff Proj Hope. 2010; 29: 57-64
        • Werner R.M.
        • Coe N.B.
        • Qi M.
        • Konetzka R.T.
        Patient outcomes after hospital discharge to home with home health care vs to a skilled nursing facility.
        JAMA Intern Med. 2019; 179: 617-623
        • Jones C.D.
        • Jones J.
        • Bowles K.H.
        • et al.
        Quality of hospital communication and patient preparation for home health care: Results from a statewide survey of home health care nurses and staff.
        J Am Med Dir Assoc. 2019; 20: 487-491
        • Jones C.D.
        • Cumbler E.
        • Honigman B.
        • et al.
        Hospital to post-acute care facility transfers: Identifying targets for information exchange quality improvement.
        J Am Med Dir Assoc. 2017; 18: 70-73
        • King B.J.
        • Gilmore-Bykovskyi A.L.
        • Roiland R.A.
        • et al.
        The consequences of poor communication during transitions from hospital to skilled nursing facility: A qualitative study.
        J Am Geriatr Soc. 2013; 61: 1095-1102
        • Gadbois E.A.
        • Tyler D.A.
        • Shield R.
        • et al.
        Lost in transition: A qualitative study of patients discharged from hospital to skilled nursing facility.
        J Gen Intern Med. 2019; 34: 102-109
        • Britton M.C.
        • Ouellet G.M.
        • Minges K.E.
        • et al.
        Care transitions between hospitals and skilled nursing facilities: Perspectives of sending and receiving providers.
        Jt Comm J Qual Patient Saf. 2017; 43: 565-572
        • Burke R.E.
        • Lawrence E.
        • Ladebue A.
        • et al.
        How hospital clinicians select patients for skilled nursing facilities.
        J Am Geriatr Soc. 2017; 65: 2466-2472
        • Ward K.T.
        • Eslami M.S.
        • Garcia M.B.
        • McCreath H.E.
        Do internal medicine residents know enough about skilled nursing facilities to orchestrate a good care transition?.
        J Am Med Dir Assoc. 2014; 15: 841-843
        • Miller R.K.
        • Keddem S.
        • Katz S.
        • et al.
        Intern transitions of care curriculum through posthospital home and skilled nursing facility visits.
        J Grad Med Educ. 2018; 10: 442-448
        • Young E.
        • Stickrath C.
        • McNulty M.C.
        • et al.
        Internal medicine residents’ perceived responsibility for patients at hospital discharge: A national survey.
        J Gen Intern Med. 2016; 31: 1490-1495
        • Young E.
        • Stickrath C.
        • McNulty M.
        • et al.
        Residents’ exposure to educational experiences in facilitating hospital discharges.
        J Grad Med Educ. 2017; 9: 184-189
        • Greysen S.R.
        • Schiliro D.
        • Curry L.
        • et al.
        “Learning by doing”—resident perspectives on developing competency in high-quality discharge care.
        J Gen Intern Med. 2012; 27: 1188-1194
        • DeCaporale-Ryan L.N.
        • Cornell A.
        • McCann R.M.
        • et al.
        Hospital to home: A geriatric educational program on effective discharge planning.
        Gerontol Geriatr Educ. 2014; 35: 369-379
        • Burke R.E.
        • Kripalani S.
        • Vasilevskis E.E.
        • Schnipper J.L.
        Moving beyond readmission penalties: Creating an ideal process to improve transitional care.
        J Hosp Med. 2013; 8: 102-109
      1. Internal medicine milestones.
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