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Open Access Study protocol

Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS)

Abby G Meyers1, Amanda Salanitro234, Kenneth A Wallston5, Courtney Cawthon6, Eduard E Vasilevskis234, Kathryn M Goggins6, Corinne M Davis6, Russell L Rothman4, Liana D Castel4, Katharine M Donato7, John F Schnelle48, Susan P Bell9, Jonathan S Schildcrout10, Chandra Y Osborn114, Frank E Harrell10 and Sunil Kripalani4*

Author Affiliations

1 Vanderbilt University School of Medicine, Nashville, TN, USA

2 VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC), HSR&D Targeted Research Enhancement Program for Patient Healthcare Behavior, Nashville, TN, USA

3 Clinical Research Center of Excellence (CRCoE), Nashville, TN, USA

4 Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University, 1215 21st Ave S, Suite 6000 Medical Center East, Nashville 37232, TN, USA

5 School of Nursing, Vanderbilt University, Nashville, TN, USA

6 Center for Health Services Research, Vanderbilt University, Nashville, TN, USA

7 Department of Sociology, Vanderbilt University, Nashville, TN, USA

8 Center for Quality Aging, Vanderbilt University, Nashville, TN, USA

9 Division of Cardiovascular Medicine, Vanderbilt University, Nashville, TN, USA

10 Department of Biostatistics, Vanderbilt University, Nashville, TN, USA

11 Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, USA

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BMC Health Services Research 2014, 14:10  doi:10.1186/1472-6963-14-10

Published: 8 January 2014

Abstract

Background

The period following hospital discharge is a vulnerable time for patients when errors and poorly coordinated care are common. Suboptimal care transitions for patients admitted with cardiovascular conditions can contribute to readmission and other adverse health outcomes. Little research has examined the role of health literacy and other social determinants of health in predicting post-discharge outcomes.

Methods

The Vanderbilt Inpatient Cohort Study (VICS), funded by the National Institutes of Health, is a prospective longitudinal study of 3,000 patients hospitalized with acute coronary syndromes or acute decompensated heart failure. Enrollment began in October 2011 and is planned through October 2015. During hospitalization, a set of validated demographic, cognitive, psychological, social, behavioral, and functional measures are administered, and health status and comorbidities are assessed. Patients are interviewed by phone during the first week after discharge to assess the quality of hospital discharge, communication, and initial medication management. At approximately 30 and 90 days post-discharge, interviewers collect additional data on medication adherence, social support, functional status, quality of life, and health care utilization. Mortality will be determined with up to 3.5 years follow-up. Statistical models will examine hypothesized relationships of health literacy and other social determinants on medication management, functional status, quality of life, utilization, and mortality. In this paper, we describe recruitment, eligibility, follow-up, data collection, and analysis plans for VICS, as well as characteristics of the accruing patient cohort.

Discussion

This research will enhance understanding of how health literacy and other patient factors affect the quality of care transitions and outcomes after hospitalization. Findings will help inform the design of interventions to improve care transitions and post-discharge outcomes.

Keywords:
Hospitalization; Patient discharge; Patient readmission; Transitions of care; Health literacy; Social determinants