Identifying Hospital Patients Who Need Early Discharge Planning for Special Dispositions: A Comparison of Alternative Techniques

A prediction rule for the use of postdischarge medical services

“…This study did not attempt to measure all factors previously identified as correlates of postdischarge medical services use, such as attitudes of patients or patients' families regarding institutionalization or economic status, 11 or prior medical resource utilization. 14 However, these data were not routinely available for this patient population, whereas all data in this decision rule were collected as a part of routine care.…”

“…2 Although discharge planning 3,4 and case management [5][6][7][8][9] services are prevalent, screening methodologies for prospectively identifying which hospitalized patients will need these services remains primitive. 10,11 Factors previously reported to be associated with the need for nursing home placement or other discharge planning services include age, gender, availability of caregivers, and functional status, 12 hospital teaching status, 13 the number of chronic medical conditions, 14 psychiatric comorbidity, 11 prior nursing home residence, 10,11,15 prior home health care use, 16 manual ability, 17 financial status, 18 educational attainment, 13 and anticipated discharge to a place other than home. 19 Despite research efforts, however, there are currently no screening instruments for discharge planning in common use.…”

“…19 Despite research efforts, however, there are currently no screening instruments for discharge planning in common use. This is in part because data collection for existing instruments requires a trained "screener" to perform chart review, 8,11,15 patient interviews, 8,12,13 cognitive or physical testing, 14 interviews with housestaff or discharge planners, 7,15,16 or administrative database review. 10 In a time of cost reduction, data collection methodologies falling outside routine care undermine the practical utility of previously proposed screening instruments.…”

“…10 In a time of cost reduction, data collection methodologies falling outside routine care undermine the practical utility of previously proposed screening instruments. 10,11,14,15,[19][20][21] A screening instrument administered at the time of admission identifying those patients most likely to need discharge planning services could make discharge planners more efficient by enabling them to target their efforts on the "at-risk" population. To our knowledge, there is no report in the literature of an instrument for predicting the need for discharge planning services derived solely from data collected routinely from patients at the time of hospital admission.…”

Predictors of Immediate and 6‐Month Outcomes in Hospitalized Elderly Patients

“…In addition, the new pressures to limit use of acute‐care services (eg, the Medicare prospective payment system) have had the effect of further emphasizing immediate hospital outcomes at the expense of longer‐term outcomes. Table 1 summarizes most of the literature on previous hospital outcome studies among older patients 1–14 . Several studies have shown that advancing age was related to several poor outcomes of hospitalization, such as increased in‐hospital mortality, 1,5 mortality at follow‐up, 10 prolonged stay, 1,9,12 and discharge to nursing homes 9,10,11,14 .…”