Prediction of post-acute care demand in medical and neurological inpatients : diagnostic assessment of the post-acute discharge score - a prospective cohort study

Conca, Antoinetta (Department of Clinical Nursing Sciences, Kantonsspital Aarau, Switzerland ; Pflege & MTTD, Fachabteilung Pflegeentwicklung, Kantonsspital Aarau, Switzerland) ; Gabele, Angela (Department of Clinical Nursing Science, Kantonsspital Aarau,) ; Reutlinger, Barbara (Department of Clinical Nursing Science, Kantonsspital Aarau,) ; Schuetz, Philipp (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Kutz, Alexander (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Haubitz, Sebastian (Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Aarau, Switzerland) ; Faessler, Lukas (Pflege & MTTD, Fachabteilung Pflegeentwicklung. Kantonsspital Aarau, Switzerland ; Department of Psychology, University of Berne, Switzerland) ; Batschwaroff, Marcus (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Schild, Ursula (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Caldara, Zeljka (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Regez, Katharina (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Schirlo, Susanne (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Vossler, Gabi (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Kahles, Timo (Department for Neurology, Kantonsspital Aarau, Switzerland) ; Nedeltchev, Krassen (Department for Neurology, Kantonsspital Aarau, Switzerland) ; Keller, Anja (Department of Social Services, Kantonsspital Aarau, Switzerland) ; Huber, Andreas (Department of Laboratory Medicine, Kantonsspital Aarau, Switzerland) ; De Geest, Sabina (Institute of Nursing Science, University of Basel, Switzerland) ; Buergi, Ulrich (Emergency Department, Kantonsspital Aarau, Switzerland) ; Tobias, Petra (Emergency Department, Kantonsspital Aarau, Switzerland) ; Simonet, Martine Louis (Service of General Internal Medicine, University Hospitals Geneva, Switzerland) ; Mueller, Beat (University Department of Internal Medicine, Kantonsspital Aarau, Switzerland) ; Schäfer-Keller, Petra (School of Health Sciences, HES-SO Fribourg)

Background: Early 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”). Methods: In 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. Results: Medical 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%. Conclusion: PACD 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. (Continued on next page)


Keywords:
Article Type:
scientifique
Faculty:
Santé
School:
HEdS-FR
Institute:
Recherche appliquée et développement Santé HEDS-FR
Date:
2018-03
Pagination:
10 p.
Published in:
BMC Health Services Research
Numeration (vol. no.):
2018, vol. 18, no. 111
DOI:
ISSN:
1756-0500
Appears in Collection:



 Record created 2019-11-14, last modified 2020-10-27

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