Patient characteristics at hospital discharge and a comparison of home care referral decisions.

Full Abstract

OBJECTIVES:
Describe the characteristics of hospitalized older adults who were not referred for home care, compare the referral decisions of hospital clinicians with those of nurses with expertise in discharge planning and transitional care, and compare the characteristics of hospitalized older adults who did not receive a home care referral with patients who did receive a home care referral.

DESIGN:
Secondary analysis, descriptive, case series.

SETTING:
Subjects were discharged to home from one of two urban hospitals in Philadelphia, Pennsylvania.

PARTICIPANTS:
Ninety-nine patients for this study were drawn from the control group (n = 186) of a prior randomized clinical trial of advanced practice nurse hospital discharge planning and home follow-up. These 99 patients, or 56 of the control group, did not receive a home care referral even though they were screened into the original study as meeting at least one of the risk criteria associated with poor postdischarge outcomes.

MEASUREMENTS:
Case studies were generated from research records of the control group patients who did not receive a home care referral. They included patient sociodemographic and health characteristics. Nurses with expertise in discharge planning and transitional care, blinded to the actual decision, reviewed each case study and made a referral decision.

RESULTS:
Case studies revealed that control group patients, discharged without home follow-up, had many characteristics associated with the need for a home care referral, with the likelihood of receiving a referral, or with developing poor postdischarge outcomes. Overall, compared with control group patients who did not receive home care, those who did were older, had a longer hospital stay, more often rated their health as fair or poor, and had worse functional status. However, transitional care nurses judged that 96 of 99 of the control group patients discharged without home care had unmet discharge needs that may have benefited from a postdischarge referral. In addition, the transitional care nurses identified 49 of these 99 patients as having a high-priority need for home care. These patients had at least three of the characteristics associated with the need for a home care referral, the likelihood of receiving a referral, or of developing poor postdischarge outcomes. High-priority patients were significantly different in many sociodemographic and health characteristics and were rehospitalized significantly more often than other control group patients who were discharged without home care (P = .032).

CONCLUSION:
Study findings have demonstrated that the majority of older adults in this sample were discharged without postdischarge referrals despite the presence of several characteristics associated with the need for home care and risk of poor discharge outcomes. Findings suggest the need for improved methods to identify and synthesize patient characteristics associated with the need for postdischarge referral and to support clinical decision-making. Insurance or homebound status should also be explored as barriers to patients receiving the postdischarge care that they need.

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Author information

Author/s: Bowles, Kathryn H (KH); Naylor, Mary D (MD); Foust, Janice B (JB);

Affiliation: University of Pennsylvania School of Nursing, Philadelphia 19104, USA. bowles(-atsign-)nursing.upenn.edu

Grants: R01-NR02095 (Agency:NINR NIH HHS)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Research Support, U.S. Gov't, P.H.S.

Journal: Journal of the American Geriatrics Society (J Am Geriatr Soc), published in United States. (Language: eng)

Reference: 2002-Feb; vol 50 (issue 2) : pp 336-42

Dates: Created 2002/05/24; Completed 2002/07/31; Revised 2008/03/10;

PMID: 12028217, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aftercare - utilization
Aged
Decision Making
Female
Health Status
Home Care Services - utilization
Hospitals, Urban
Humans
Male

Male
Medical Staff, Hospital
Needs Assessment
Nursing Staff, Hospital
Organizational Case Studies
Patient Discharge - standards
Philadelphia
Referral and Consultation - statistics & numerical data
Socioeconomic Factors

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