Readiness for discharge from subacute mental health units for older people: Using available measures to support clinical decision-making.

Abstract

Prior to introduction of the Health of the Nation Outcome Scale 65+ (HoNOS65) as a mandated measure, the three subacute mental health units for older people in the present study routinely used the Care Planning Assessment Tool (CPAT) for clinical review and discharge planning. The aims of the present study were to compare these two measures of behavioural change during subacute admissions, to examine associations with discharge readiness, and to assess their overall contributions to discharge planning decisions. This is a prospective, comparative measurement study. HoNOS65 (severity) and CPAT (frequency) behavioural subscale ratings were collected from admission to discharge for older patients with very severe and persistent behavioural and psychological symptoms of dementia. Readiness for discharge data (yes/no), collected from multidisciplinary review meetings, was used as the outcome in all analyses. In combination, these measures achieved only modest positive predictive value (52.8%) but good negative predictive value (90.4%). Consequently, patients above the cut-point on both measures are reasonably unlikely to be discharge ready. The combined use of a standard outcome measure of severity along with a specialized measure of frequency is recommended to support and enhance discharge planning decisions in this population.