2.50
Hdl Handle:
http://hdl.handle.net/10755/150725
Type:
Presentation
Title:
Prospective testing of a screen for discharge planning outcomes
Abstract:
Prospective testing of a screen for discharge planning outcomes
Conference Sponsor:Sigma Theta Tau International
Conference Year:2001
Conference Date:June, 2001
Author:Holland, Diane
P.I. Institution Name:Mayo Clinic
While the positive effects of discharge planning on cost and quality outcomes is acknowledged, early identification of a subgroup of hospitalized patients at risk of multiple poor outcomes remains elusive - limiting the potential benefits of the discharge planning intervention. Interestingly as one reviews the literature, across studies a similar set of variables seems to predict multiple outcomes. Unfortunately, most studies have used retrospective designs to examine single outcome variables or have had small sample sizes if a prospective design was used. There has been limited examination of whether the same clusters of variables derived from the same patients predict multiple outcomes. Objectives: The objectives of this study were to a) Test the predictive validity of the PRA (Probability of Readmission) a widely published screen for risk of readmission against readmission and the additional outcomes of prolonged length of stay, disposition, and need for complex discharge planning intervention, b) Examine the influence of referral bias on the predictive validity and utility of the screen, and c) Determine whether other clinical variables readily available at the time of admission improve the predictive validity and utility of this screen for multiple outcomes. Design: Prospective observational. Population, Sample, Setting, Years: Systematic sampling was used to enroll 1,000 hospitalized adults aged 18-101 at a US tertiary care center from May - September 1998. Follow-up continued through September 1999. Variables studied: Self-rated health, age, gender, disease complexity, functional status, cognitive status, nutritional status, availability of home support, disease complexity, readmission, length of stay, discharge disposition, and need for complex discharge planning interventions. Methods: Following human subjects review and obtaining informed consent, the screen was administered to subjects within one day after hospital admission. Interrater agreement between nurses serving as data collectors was established through training, and maintained throughout the data collection period. Advanced practice nurses in a discharge-planning role were blinded to the subject’s screen results, and proceeded to determine the need for complex discharge planning intervention following “usual” procedures within the institution. Disposition and plans for continuing care data were collected by chart review at the time of discharge. A retrospective record review was then completed at one-year to retrieve additional clinical variables and readmission data. Chi-square, Wilcoxon rank sum test, stepwise logistic regression, and receiver operating curve characteristics were employed to analyze the data. Findings: Preliminary analyses suggest that self-rated health, and secondarily, age were better predictors of poor outcomes than the total score obtained form the screening instrument, with areas under ROC curves approaching 0.8 for each item. Additional analyses suggest that referral patterns may bias the results obtained in the examination of outcomes such as readmission. Conclusions: The predictive validity obtained in this study varies substantially from previously published retrospective analyses, and confirms the need to prospectively examine screening tools. Implications: Development of an early screen to identify hospitalized patients who are at risk for poor outcomes and would benefit from targeted, enhanced discharge planning interventions would likely improve multiple patient outcomes. Further research is needed to identify key clinical variables available at the time of admission that assists clinicians in decision-making around discharge planning interventions.
Repository Posting Date:
26-Oct-2011
Date of Publication:
Jun-2001
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleProspective testing of a screen for discharge planning outcomesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/150725-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Prospective testing of a screen for discharge planning outcomes</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2001</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">June, 2001</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Holland, Diane</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Mayo Clinic</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">holland.diane@mayo.edu</td></tr><tr><td colspan="2" class="item-abstract">While the positive effects of discharge planning on cost and quality outcomes is acknowledged, early identification of a subgroup of hospitalized patients at risk of multiple poor outcomes remains elusive - limiting the potential benefits of the discharge planning intervention. Interestingly as one reviews the literature, across studies a similar set of variables seems to predict multiple outcomes. Unfortunately, most studies have used retrospective designs to examine single outcome variables or have had small sample sizes if a prospective design was used. There has been limited examination of whether the same clusters of variables derived from the same patients predict multiple outcomes. Objectives: The objectives of this study were to a) Test the predictive validity of the PRA (Probability of Readmission) a widely published screen for risk of readmission against readmission and the additional outcomes of prolonged length of stay, disposition, and need for complex discharge planning intervention, b) Examine the influence of referral bias on the predictive validity and utility of the screen, and c) Determine whether other clinical variables readily available at the time of admission improve the predictive validity and utility of this screen for multiple outcomes. Design: Prospective observational. Population, Sample, Setting, Years: Systematic sampling was used to enroll 1,000 hospitalized adults aged 18-101 at a US tertiary care center from May - September 1998. Follow-up continued through September 1999. Variables studied: Self-rated health, age, gender, disease complexity, functional status, cognitive status, nutritional status, availability of home support, disease complexity, readmission, length of stay, discharge disposition, and need for complex discharge planning interventions. Methods: Following human subjects review and obtaining informed consent, the screen was administered to subjects within one day after hospital admission. Interrater agreement between nurses serving as data collectors was established through training, and maintained throughout the data collection period. Advanced practice nurses in a discharge-planning role were blinded to the subject&rsquo;s screen results, and proceeded to determine the need for complex discharge planning intervention following &ldquo;usual&rdquo; procedures within the institution. Disposition and plans for continuing care data were collected by chart review at the time of discharge. A retrospective record review was then completed at one-year to retrieve additional clinical variables and readmission data. Chi-square, Wilcoxon rank sum test, stepwise logistic regression, and receiver operating curve characteristics were employed to analyze the data. Findings: Preliminary analyses suggest that self-rated health, and secondarily, age were better predictors of poor outcomes than the total score obtained form the screening instrument, with areas under ROC curves approaching 0.8 for each item. Additional analyses suggest that referral patterns may bias the results obtained in the examination of outcomes such as readmission. Conclusions: The predictive validity obtained in this study varies substantially from previously published retrospective analyses, and confirms the need to prospectively examine screening tools. Implications: Development of an early screen to identify hospitalized patients who are at risk for poor outcomes and would benefit from targeted, enhanced discharge planning interventions would likely improve multiple patient outcomes. Further research is needed to identify key clinical variables available at the time of admission that assists clinicians in decision-making around discharge planning interventions.</td></tr></table>en_GB
dc.date.available2011-10-26T10:41:09Z-
dc.date.issued2001-06en_GB
dc.date.accessioned2011-10-26T10:41:09Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
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