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Background: Teaching interns patient-centered communication skills, including making structured telephone calls to patients following discharge, may improve transitions of care. Objective: To explore associations between a patient-centered care (PCC) curriculum and patients’ perspectives of the quality of transitional care. Methods: We implemented a novel PCC curriculum on one of four inpatient general medicine resident teaching teams in which interns make post-discharge telephone calls to patients, contact outpatient providers, perform medication adherence reviews, and engage in patient-centered discharge planning. Between July and November of 2011, we conducted telephone surveys of patients from all four teaching teams within 30 days of discharge. In addition to asking if patients received a call from their hospital physician (intern), we administered the 3-Item Care Transitions Measure (CTM-3), which assesses patients’ perceptions of preparedness for the transition from hospital to home (possible score range 0–100). Results: The CTM-3 scores (mean±SD) of PCC team patients and standard team patients were not significantly different (82.4±17.3 vs. 79.6±17.6, p=0.53). However, regardless of team assignment, patients who reported receiving a post-discharge telephone call had significantly higher CTM-3 scores than those who did not (84.7±16.0 vs. 78.2±17.4, p=0.03). Interns exposed to the PCC curriculum called their patients after discharge more often than interns never exposed (OR=2.78, 95% CI [1.25, 6.18], p=0.013). Conclusions: The post-discharge telephone call, one element of PCC, was associated with higher CTM-3 scores – which, in turn, have been shown to lessen patients’ risk of emergency department visits within 30 days of discharge.

Abstract Patient-centered care is an important aspect of medicine. The Johns Hopkins Initiative Curriculum aims to teach residents to view patients as individuals and to consider the context of their lives outside the hospital in order to provide patient-centered, and safe, care across transitions. Specifically, this curriculum was developed to reform graduate medical education by teaching residents to: (1) provide more patient-centered care by understanding the psychosocial context of each patient's illness, and knowing patients as individuals; (2) optimize care across transitions from the hospital to postdischarge setting; and, (3) educate and empower patients in shared decision-making about treatments. This curriculum is meant to be administered over a 4-week period with residents receiving both didactic instruction and observation by attending physicians during resident-patient interactions. Instruction is provided across seven content areas consisting of: (1) medication adherence, (2) pharmacy curriculum, (3) call to next provider of care, (4) patient-centered discharge, (5) telephone contact with patients after discharge, (6) follow-up visits with patients after discharge (home and sub-acute visits), and (7) the challenging provider-patient relationship. Each area is accompanied by detailed administration directions in an accompanying Instructor's Guide. We are currently engaged in studies of the impact of this curriculum on learners and patients. In addition to providing more patient-centered care, we hope to demonstrate benefits in other educational outcomes, including medical knowledge, self-awareness, systems-based practice, and communication skills. We plan to assess whether patients report better relationships with their physicians and an improved understanding of their medical conditions and care. We also hope to demonstrate improved clinical outcomes such as reduced 30-day readmission rates and increased follow-through with recommended treatments and studies after discharge.