Written discharge communication of diagnostic and decision-making information for persons living with dementia during hospital to skilled nursing facility transitions.

The records are from 2003 to 2009, so they may not reflect current electronic health record use or interoperability. The cohort included only people with dementia who also had stroke or hip/femur fracture and were discharged to a skilled nursing facility. The data came from two hospitals in one Midwestern city, with patients sent to many different skilled nursing facilities. Denominators changed by item because some information was not documented in the electronic health record or discharge summary. The study measured documentation gaps, not whether those gaps caused poor care or patient outcomes. Code status alignment was examined only among the 81 patients whose discharge summary included a code designation.

The authors declared no potential conflicts of interest. The article is listed as supported by NIH extramural research.

Do not use these rates as current evidence that every hospital-to-SNF discharge summary for dementia patients omits decision-making information. The study reviewed records from 2003 to 2009, included only people with dementia plus stroke or hip fracture, and measured documentation gaps rather than outcomes.