Discharge Planning Decision Making by Hospitalized Patients

Abstract

Although studies have examined decision making in discharge planning, few have studied the decision-making process from the patient's perspective. Using structured cases, this pilot study examined patients'decisions fordischarge planning. Four variables were manipulated to create 24 unique cases. These variables included patient living situation, personal assistance needs, home assistance needs, and complexity of medication regime. Respondents rank ordered the appropriateness of four discharge options (i.e., outpatient clinic, housekeeping/chore, home health nursing, and nursing home care) for each case. Eighty chronically ill hospitalized patients from two VA hospitals served as subjects. Patient living arrangement, home assistance needs, and personal assistance needs had strong relationships with the perceived appropriateness of outpatient and nursing home care. When patient status was good, nursing home care was clearly an inappropriate solution from the patients' perspective. Outpatient care was ranked as less appropriate when patient status deteriorated. The only significant association with home health care was personal assistance needs. Medication complexity had no significant association with the four discharge options.There is a growing consensus that patients should be involved in decision making about posthospital discharge plans (Coulton,