Abstract
BackgroundEarly identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. With a focus on interprofessional assessment of biopsychosocial risk, this study’s aim was to assess medical and neurological patients’ post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as the outcome (“gold standard”).MethodsIn this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432 medical and 464 neurological patients (total n = 1896) were included consecutively between February and October 2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital stays, and interviews at day 30 post-hospital admission. To gauge the scores’ accuracy, we plotted receiver operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and specificity at various cut-off levels.ResultsMedical patients’ day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of ≥8 points, day 1 and 3 sensitivities were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients’ scores showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78, sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%.ConclusionPACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical patients on day 3. To confirm and refine these results, PACD scores’ value to guide discharge planning interventions and subsequent impact on hospital stay warrants further investigation.Trial registrationClinialTrials.gov Identifier, NCT01768494.
Highlights
Identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays
Characteristics of the patients discharged to a PAC facility n = 152 discharged home n = 1280
Medical patients screened by the post-acute care discharge (PACD) day-3 showed the greatest range in lengths of stay: on average, low-risk patients stayed 6 days, intermediate-risk. This large-scale study in medical and neurological patients assessed the diagnostic accuracy of the original PACD day-3 instrument versus that adapted for day-1 use, and analyzed the predictive value of each regarding PAC facility transfer
Summary
Identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital stays. Along with assessment of in-patient care needs and functional deterioration, early measures should include initial postdischarge care planning [8,9,10,11,12,13,14] and timely involvement of social workers or case managers to plan transfers to PAC facilities While these actions will entail moderate administrative burdens, along with increased interprofessional teamwork and communication at admission, the potential reductions in stay lengths and improvements to patient outcomes support this exploration
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