Post-acute Care Patients Research Articles

Effectiveness of case management and post‐acute services in older people after hospital discharge

To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Four university-affiliated metropolitan general hospitals in Victoria. All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). The PAC program is beneficial in the transition from hospital to the community in older patients.

Factors in perceived hospital discharge planning effectiveness.

Hospital discharge planning is the process of assessing the needs of hospitalized patients for post-acute care and developing a coordinated plan to provide the care needed. It is an important component of both the financial viability of the hospital and of the overall quality of care provided to the patient across health care settings, and has historically been an important part of social work practice. This research, based on a random sample survey of U.S. non-federal acute medical/surgical hospitals (N = 378 hospitals), suggests those variables that may be most important in shaping the effectiveness of the hospital discharge planning program. A multivariate analysis framework is used to identify those variables that have the strongest independent effect on effectiveness, and to assess the relative strength of each. Power (including discharge planner influence and physician and hospital administrator support) and role clarity emerge as the most important predictors of perceived effectiveness. The model of discharge planning used and characteristics of the hospital (such as size or urban-rural location) are not significant independent predictors. The single most important factor is cooperation and support from the physician staff of the hospital. This research suggests that organizational factors, rather than the use of a particular "system" of discharge planning, may be most important in discharge planning effectiveness.