Developing a Model of Discharge Planning Based on Patient Characteristics

Abstract

Previous research using hypothetical case scenarios has suggested a model of decision making in discharge planning involving at least two steps. The first is to assess the availability of a caregiver, and the second is to examine the complexity of the patient's situation regarding follow-up care needs, physical functioning, and compliance. The combination of these factors then influences the choice of discharge option. The present study attempted to validate and extend the model using actual cases in a retrospective chart review. The four variables of the original model correctly classified 68% of patients by discharge type and accounted for 29% of the variance. An expanded model that included chore assistance, living situation, caregiver availability, medical need, and patient age was able to account for an additional 19% of the variance in the discharge plan.

Integrated Literature Review of Continuity of Care: Part 1, Conceptual Issues

“…Adequate assessment of patients' needs after hospitalization was a frequent factor contributing to continuity of care. Tools to predict home care needs (Bull, 1994;Solomon et al, 1993;Weaver & Burdi, 1992), patient assessment and need for further services (Haddock, 1991;Hixon et al, 1992;Jewell, 1993;Moy & Hogan, 1993;Williams et al, 1992), the importance of family involvement and quality improvement measures (McWilliam, 1992), the effect of patient acuity on referral information and service provision (Anderson & Helms, 1993b;Dorwart & Hoover, 1994), and system capacity to manage technically complex care (Sevick et al, 1992) have all been linked as factors in continuity of care.…”

Statement on Home Care for Patients with Respiratory Disorders

“…Medical diagnosis is only one of several factors associated with the need for episodic home health care after hospital discharge for medical or surgical treatment. Factors found in at least one study to be associated with home health referral posthospitalization are complex medical needs (need for skilled nursing care, or dually diagnosed with COPD and chronic heart failure), activity of daily living (ADL) and instrumental activity of daily living (IADL) limitations, lack of availability of a spouse caregiver, low level of social support, educational attainment of less than 12 years, need for chore or personal care services, and prior home care use (27)(28)(29)(30). Garrard and colleagues (31) developed a "Need for Home Health Services Check List" using expert consensus, including nurses, to identify health, psychosocial, and behavioral problems, and education and coordination needs suggesting the need for home health services after hospital discharge.…”

“…Inability to consistently demonstrate better outcomes in patients receiving respiratory home health care compared with those not receiving it makes it difficult to validate referral criteria for those who can benefit from such care. Expert consensus led to the recommendations for consideration of home health referral for respiratory patients in this statement, but these recommendations differ from correlates of home health referrals found in studies of general home health samples (28)(29)(30) and in patients with COPD and congestive heart failure (27). At present, guidelines for referral should be applied on the basis of medical judgment by chest physicians and pulmonologists.…”

Discharge Planning Decision Making by Hospitalized Patients

“…However, the placement recommendations were made by discharge planners. Weaver and Bryant (1990) generated a decision-making model using provider responses to structured cases and then validated the model using data from a chart audit (Weaver & Burdi, 1992). The model identified seven variables, including caregiver availability, patient functional status, patient compliance, medical needs, patient living situation, age, and need for chore assistance, that accounted for 48% of the variance in discharge plans.…”