Factors Identified by Experts to Support Decision Making for Post Acute Referral

被引:54
作者
Bowles, Kathryn H. [1 ]
Holmes, John H. [2 ]
Ratcliffe, Sarah J. [2 ]
Liberatore, Matthew [3 ]
Nydick, Robert [3 ]
Naylor, Mary D. [1 ]
机构
[1] Univ Penn, Sch Nursing, Philadelphia, PA 19101 USA
[2] Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
[3] Villanova Univ, Dept Decis & Informat Technol, Philadelphia, PA USA
关键词
aged; decision support systems; clinical; discharge planning; elderly; home care; patient discharge; referral and consultation expert systems; RANDOMIZED CLINICAL-TRIAL; HOME CARE; OLDER PATIENTS; DISCHARGE; SERVICES; REHABILITATION; ACCESS; RISK; HOSPITALIZATION; READMISSION;
D O I
10.1097/NNR.0b013e318199b52a
中图分类号
R47 [护理学];
学科分类号
1011 ;
摘要
Background. Each year, more than 13 million post acute referral decisions are made for Medicare recipients, yet there are no national, empirically derived decision support tools to assist in making these important decisions. Objectives: The aim of this study was to elicit expert knowledge about factors important to referral decision making and identify the characteristics of hospitalized patients who need a post acute referral. Methods: This was a retrospective and prospective mixed-methods study of the referral decisions made by discharge planning experts for 355 hospitalized older adults. Variables included sociodemographics, living arrangement, insurance, diagnosis, comorbid conditions, adverse events, medications, home care use, hospitalization in last 30 days or 6 months, patients' perception of need for and use of assistive devices or post acute services, length of stay, cognition, self-rated health, depression, functional status, and post acute referral decision. Results: The final model identified six factors associated with the need for a post acute referral. A cutpoint was derived with a sensitivity and specificity of 87.6% and 63.2%, respectively. Experts were more likely to refer patients who had no or intermittent help available (odds ratio [OR] = 3.0), major walking restrictions (OR = 6.5), less than excellent self-rated health (3.1 and 4.0 times more likely with good and fair-poor health, respectively), remained in the hospital longer (OR = 1.2), and had higher depression scores (OR = 1.1) or number of comorbidities (OR = 1.2). Discussion: This study begins to identify information useful to clinicians caring for hospitalized older adults who may benefit from post acute services. By assuring the systematic, valid, and reliable collection of these items, the multidisciplinary team is alerted to patients who may benefit from post acute services. Further work is needed to increase the specificity and generalizability of the model and to test its effects on patient and clinician outcomes.
引用
收藏
页码:115 / 122
页数:8
相关论文
共 43 条
[1]  
Adams K., 2003, PRIORITY AREAS NATL
[2]  
[Anonymous], 1994, An introduction to the bootstrap: CRC press
[3]  
[Anonymous], Data Mining Practical Machine Learning Tools and Techniques with Java
[4]  
[Anonymous], 1997, Analysis of Incomplete Multivariate Data, DOI [DOI 10.1201/9780367803025, DOI 10.1201/9781439821862]
[5]  
[Anonymous], 2007, REP C PROM GREAT EFF
[6]   Post-acute referral decisions made by multidisciplinary experts compared to hospital clinicians and the patients' 12-week outcomes [J].
Bowles, Kathryn H. ;
Ratcliffe, Sarah J. ;
Holmes, John H. ;
Liberatore, Matthew ;
Nydick, Robert ;
Naylor, Mary D. .
MEDICAL CARE, 2008, 46 (02) :158-166
[7]   Patient characteristics at hospital discharge and a comparison of home care referral decisions [J].
Bowles, KH ;
Naylor, MD ;
Foust, JB .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 2002, 50 (02) :336-342
[8]   Access to postacute rehabilitation [J].
Buntin, Melinda Beeuwkes .
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 2007, 88 (11) :1488-1493
[9]   LONGITUDINAL-STUDY OF DEPRESSION AND HEALTH-SERVICES USE AMONG ELDERLY PRIMARY-CARE PATIENTS [J].
CALLAHAN, CM ;
HUI, SL ;
NIENABER, NA ;
MUSICK, BS ;
TIERNEY, WM .
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY, 1994, 42 (08) :833-838
[10]   The use of concept maps during knowledge elicitation in ontology development processes - the nutrigenomics use case [J].
Castro, Alexander Garcia ;
Rocca-Serra, Philippe ;
Stevens, Robert ;
Taylor, Chris ;
Nashar, Karim ;
Ragan, Mark A. ;
Sansone, Susanna-Assunta .
BMC BIOINFORMATICS, 2006, 7 (1)