Ever feel like you or your loved ones are shuffled from the hospital to home or nursing home without seeing any of your own doctors? You’re not alone.

Twenty or 30 years ago when a patient was admitted to the hospital, his or her doctor usually came to visit and help coordinate care. Now a new study of hospitalized Medicare patients quantifies what many already know: Most older people can’t look forward to a visit from any of their regular doctors.

A majority of Medicare patients are seen by physicians that they have never met before, according to a study published today in the Journal of the American Medical Association. The research contributes to a growing body of evidence showing that the lack of continuity of care between hospitals and homes or nursing homes contributes to poor patient satisfaction, shoddy preventive health care, improper use of medication and high hospitalization rates.

Gulshan Sharma, M.D., lead author of the study and an assistant professor in the department of internal medicine at the University of Texas Medical Branch in Galveston, Texas, says the patient-physician relationship is crucial to coordinating and connecting an individual’s care.

Sharma says if one of your regular doctors visits when you are hospitalized, “the physician knows about you, knows who you are, knows your medical history and knows what happens to you [in the hospital]. When you get out, he knows what he ordered, what he has done and what he needs to follow up on.”

Sharma and a team of researchers examined more than 3 million hospital admissions for Medicare patients from 1996 to 2006. They checked to see whether the patient’s primary care physician or any of the patient’s other physicians visited the patient in the hospital and found that in 1996 about half of the Medicare patients saw doctors they had seen before. By 2006 only 40 percent had a visit from a doctor they knew.

Hospitalized patients had even fewer visits from their primary care physicians, down from about 44 percent in 1996 to less than a third in 2006.

Previous studies have found that when people leave the hospital, they often don’t understand treatment plans, discharge information, medications or follow-up care. One recent study found that as many as 75 percent of patients can’t name any doctor who took care of them in the hospital.

Sharma says that with little financial incentive and increased patient load, many busy doctors don’t take the time to make hospital visits. Studies have shown that when older people make the transition from the hospital to another health care facility, they often have trouble remembering doctors’ instructions and aren’t sure how their recovery should progress.

“The critical time in anybody’s medical history is in these transitions,” Sharma said, adding that much is “lost in translation.” He said patient transitions can be improved by having the same physician take care of patients along the whole trajectory of illness or having better communications among doctors, hospitals and patients.

The lack of coordination has consequences. Post-discharge medication errors are common, and necessary follow-up care and testing often don’t happen. The confusion and lack of information may contribute to high rehospitalization rates—another study, published in the New England Journal of Medicine earlier this month, found that as many as a third of Medicare patients are readmitted within 90 days, and a fifth within a month of being discharged.

A recent AARP Public Policy Institute survey of almost 2,500 patients with chronic medical conditions such as diabetes or arthritis found that nearly 20 percent said their transitional care was not well coordinated. The survey also found that those respondents were more likely to be readmitted to a health care facility within a month of discharge.

“The return home after a hospital stay, especially a prolonged one, can be stressful for individuals and their families,” says the accompanying report, “Chronic Care: A Call to Action for Health Reform.” The report says many older patients who leave the hospital with a chronic illness either do not receive or do not understand discharge instructions, treatment plans, medication regimes or follow-up instructions.

Albert Siu, M.D., professor and chairman of geriatrics at Mount Sinai School of Medicine in New York, says that over the last two decades he has seen a downward trend in continuity of care for older adults that spans a broad range of hospital transitions: from outpatient to hospital, hospital to outpatient and even within the hospital—with nurses and residents less likely to follow the same patient from day to day in the hospital.

So what does all this mean for the patient or caregiver trying to navigate this fragmented system?

“It means having a clear expectation when you leave the hospital of what should occur next, so that you can tell that something has fallen between the cracks and that needs to be corrected,” Siu says, adding that the lack of coordination means the caregiver role is more crucial than ever.

“Caregivers have to assume some of the role of patient advocate,” Siu says “and to educate themselves in the medical care that may need to occur after the hospital stay.”

How to Keep From Falling Through the Cracks

Drs. Siu and Sharma offer tips for patients leaving the hospital and for their caregivers:

* Ask whether the hospital doctor has contacted your primary care physician.

* Ask whether there’s any paperwork you can keep.

* Know whom to see for follow-up care.

* Ask how to schedule follow-up tests.

* Know when to start and stop medications.

* Ask about potential side effects of medications and whom to call if you experience them.

* Ask what signs or symptoms warrant a call or visit to the doctor’s office.

Resources:

The Centers for Medicare & Medicaid Services offers a “Planning for Your Discharge” brochure with advice and checklists for preparing to leave a hospital, nursing home or other health care setting.

The Care Transitions Program, developed by Eric Coleman, M.D., and colleagues at the University of Colorado, has a discharge preparation checklist and other tools.

Elizabeth Agnvall is a contributing editor at the AARP Bulletin.