A prediction rule for the use of postdischarge medical services |
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Authors: | David G Fairchild MD MPH Mairead L Hickey RN PhD E Francis Cook ScD Rita M McCarthy RN MS Laura P Rossi RN MS Samantha C Timmons BA Carol M Mangione MD MSc Dr Thomas H Lee MD MSc |
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Institution: | Section for Clinical Epidemiology, the Division of General Medicine, and the Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.,;Department of Quality Measurement and Improvement, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.,;Department of Nursing, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.,;Division of General Internal Medicine and Health Services Research, UCLA School of Medicine, Los Angeles, Calif. |
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Abstract: | OBJECTIVE: To develop and validate a prediction rule screening instrument, easily incorporated into the routine hospital admission assessment,
that could facilitate discharge planning by identifying patients at the time of admission who are most likely to need postdischarge
medical services.
DESIGN: Prospective cohort study with separate phases for prediction rule development and validation.
SETTING: Urban teaching hospital.
PATIENTS/PARTICIPANTS: General medical service patients, 381 in the derivation phase and 323 in the validation phase, who provided self-reported
medical history, health status, and demographic data as a part of their admission nursing assessment, and were subsequently
discharged alive.
MEASUREMENTS AND MAIN RESULTS: Use of postdischarge medical services such as visiting nurse or physical therapy, medical equipment, or placement in a rehabilitation
or long-term care facility was determined. A prediction rule based on a patient’s age and Medical Outcomes Study 36-Item Short
Form Health Survey (SF-36) physical function and social function scores stratified patients with regard to their risk of using
postdischarge medical services. In the validation set, the rate of actual postdischarge medical service use was 15% (15 of
97), 36% (39 of 107), and 58% (57 of 98) among patients characterized by the prediction rule as being at “low”, “intermediate,”
and “high” risk of using postdischarge medical services, respectively.
CONCLUSIONS: This prediction rule stratified general medical patients with regard to their likelihood of needing discharge planning to
arrange for postdischarge medical services. Further research is necessary to determine whether prospective identification
of patients likely to need discharge planning will make the hospital discharge planning process more efficient.
Presented at the Society of General Internal Medicine annual meeting, April 1994. |
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Keywords: | prediction rule discharge planning health status |
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