DDHA 9901 Week 4 Evidence Log Example

What the Hunt for Evidence Turned Up, Including the Sources That Returned Nothing: An Evidence Log for the Discharge Summary Transmission Problem

Student Name

Walden University

DDHA 9901: Practice-Based Problem Identification

Instructor Name

Month Day, Year

What the Hunt for Evidence Turned Up, Including the Sources That Returned Nothing: An Evidence Log for the Discharge Summary Transmission Problem

How the Log Was Built

This log records the search for evidence that discharge summaries from Larchmont Health, a composite two-hospital system, fail to reach outside primary care practices before patients' first follow-up visits. It lists every source opened, the period requested, what was actually obtained and a short verdict on whether it speaks to the claim. Sources that returned nothing remain in the log with the reason, because an empty search is itself a finding: it shows where the organization does not record something it might be expected to know. The claim being tested comes from the rewritten problem statement, covering adult medical discharges home from March through August 2026 for patients followed by clinicians who do not use the system's record.

The Log

Table 1

Evidence Log, Internal and Published Sources

Counts and periods are from the composite system's records; the published and regulatory sources are cited in the text below.

What the Internal Sources Show

The most useful matched data come from the accountable care subset, the 1,140 discharges whose follow-up visits appear in Medicare claims. Of those with a first primary care visit within 14 days of discharge and a primary care clinician outside the shared record, about 610 patients, the secure message log shows the summary sent before the visit for 44%. For June to August, when fax records exist, another 12% of that period's patients were matched to a fax sent before the visit. For the remainder, no record shows the summary leaving the hospital before the visit. That remainder includes patients whose registration listed no primary care clinician, which means the record system had nowhere to send the summary.

The signature data change the shape of the problem. Summaries are signed promptly, a median of 1.6 days after discharge, well within the 30-day completion limit the federal medical record rule sets (42 C.F.R. § 482.24). Completion is not the main failure. Sending is.

What the Empty Entries Show

Three sources returned little or nothing, and each says something. Larchmont does not hold follow-up visit dates for most independent practices, so it cannot know, in its ordinary course of operations, whether its summaries arrive in time; it learns of failures only when practices complain. The fax server purges its log after 90 days, so any older failure is unrecoverable. And practices' complaints were never logged, so the organization has no record of a problem everyone has heard about. The discharge planning rule requires hospitals to pass along the information that the clinicians taking over a patient's care will need (42 C.F.R. § 482.43), yet nothing in Larchmont's records shows whether that transfer happened for most patients.

What the Published Sources Show

Three studies show that the pattern reaches beyond one system. Kripalani et al. (2007), reviewing studies of information transfer between hospital and primary care physicians, found discharge summaries available at the first follow-up visit in only a minority of cases. A study of patients in Ontario found a trend toward fewer readmissions when the summary was available at the follow-up visit, though it did not reach statistical significance (van Walraven et al., 2002). Hoyer et al. (2016) linked longer times to complete summaries with higher readmission risk across Maryland hospitals. Larchmont's data suggest a variation on the published pattern: summaries are completed quickly but often not delivered.

Next Steps in Gathering Evidence

Three steps would close the largest gaps. First, the five largest independent practices, which see about half of the outside follow-up visits, will be asked to share visit dates for Larchmont discharges under the existing accountable care data agreement, which would extend the matched sample beyond Medicare patients. Second, information technology has agreed to retain fax server logs for twelve months from November, so that future failures can be traced. Third, patient access will audit a sample of 200 registrations to measure how often the primary care field names the wrong practice rather than none, since a wrong practice sends the summary to the wrong place without anyone noticing.

Limits of the Evidence

The matched data cover Medicare accountable care patients only, who are older than the hospitals' patients as a whole and may differ in how their follow-up is arranged. The fax log covers three months. And a summary sent before a visit is not the same as a summary read; the evidence shows transmission, not use, and no source examined here records whether a clinician opened it.

References

Conditions of participation for hospitals: Discharge planning, 42 C.F.R. § 482.43 (2025).

Conditions of participation for hospitals: Medical record services, 42 C.F.R. § 482.24 (2025).

Hoyer, E. H., Odonkor, C. A., Bhatia, S. N., Leung, C., Deutschendorf, A., & Brotman, D. J. (2016). Association between days to complete inpatient discharge summaries with all-payer hospital readmissions in Maryland. Journal of Hospital Medicine, 11(6), 393-400. https://doi.org/10.1002/jhm.2556

Kripalani, S., LeFevre, F., Phillips, C. O., Williams, M. V., Basaviah, P., & Baker, D. W. (2007). Deficits in communication and information transfer between hospital-based and primary care physicians: Implications for patient safety and continuity of care. JAMA, 297(8), 831-841. https://doi.org/10.1001/jama.297.8.831

van Walraven, C., Seth, R., Austin, P. C., & Laupacis, A. (2002). Effect of discharge summary availability during post-discharge visits on hospital readmission. Journal of General Internal Medicine, 17(3), 186-192. https://doi.org/10.1046/j.1525-1497.2002.10741.x