Improving the post-acute care discharge score (PACD) by adding patients' self-care abilities: A prospective cohort study.

Daniel Koch,Sebastian Haubitz,Helen Weber,Alexander Kutz,Beat Mueller,Antoinette Conca,Katharina Regez,Philipp Schuetz,Matthew John Meyer

doi:10.1371/journal.pone.0214194

Abstract

BackgroundReducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the post-acute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients.MethodsWe included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy.ResultsOut of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864–0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics also showed significant improvements with regard to net reclassification index (14.2%, p<0.05) and integrated discrimination improvement (4.83%, p<0.05).ConclusionsIncorporating an early assessment of patients’ actual intrahospital self-care ability to the post-acute care discharge score led to an improved prognostic accuracy for identifying adult, medical and neurological patients at risk for discharge to a post-acute care facility.

Highlights

Discharge delays lead to unnecessary additional hospital days and are an important cost-factor for acute-care institutions with payment based on diagnosis-related groups [1,2,3,4]
The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care
Multivariate analysis showed that the self-care index is an outcome predictor

Summary

Introduction

Discharge delays lead to unnecessary additional hospital days and are an important cost-factor for acute-care institutions with payment based on diagnosis-related groups [1,2,3,4]. In order to keep the waiting time until discharge as short as possible, it is essential to appropriately identify patients with the risk of leaving to a post-acute care (PAC) facility as early as possible. This allows early discharge planning and reduction of delayed hospital discharge. For this purpose, the screening instrument post-acute care discharge score (PACD) was recently proposed [6]. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. Our aim was to investigate whether the addition of the postacute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients

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Conclusion