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

Bowles, Kathryn H.; Holmes, John H.; Ratcliffe, Sarah J.; Liberatore, Matthew J.; Nydick, Robert L.; Naylor, Mary D.

doi:10.1097/nnr.0b013e318199b52a

Cited by 53 publications

(46 citation statements)

References 30 publications

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“…Our study partially confirmed the factors reported by Bowles et al [7] to identify the patients' requiring post-discharge care. In particular, they were important to determine their level of healthcare dependency: the presence of at least two neurological diseases and the lack of autonomy in carrying out IADLs (e.g., using public transport, preparing their meals, using money, taking medication, getting washed and dressed, and telephoning).…”

Section: Discussionsupporting

confidence: 81%

“…On the basis of a review of retrospective, prospective, and mixed studies focusing on planning discharge for older hospitalized patients, Bowles et al [7] came to the conclusion that older people with intermittent or no domiciliary support, with difficulty walking, poor awareness of their own health conditions, long hospital stay, depression, and a large number of comorbidities should have the priority to be receive post-discharge services.…”

Section: Introductionmentioning

confidence: 99%

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Addressing Healthcare Needs in Older People after Discharge

Proietti¹,

Compagnone²,

Liotta³

2014

AAR

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Healthcare needs should be addressed even when patients return home. The purpose of this study was to support a multidimensional assessment upon discharge to plan domiciliary care. Materials and Methods: This is a multicentre cross-sectional study that uses the Geriatric Functional Assessment questionnaire to assess healthcare needs. The questionnaire was administered upon discharge to 358 people aged over 65. Results: About 20% of our sample required healthcare support after discharge and 32% needed some sort of supervision. Most of the healthcare requirements involved socio-economic needs, neurological diseases, and inability to autonomously perform instrumental activities of daily living. Discussion: It is crucial to have an optimal discharge plan for older inpatients. Nurses play a key role in managing the care continuum process, and they have the instruments to select those requiring "supported discharge", and collaborate with district nurses who can arrange healthcare interventions jointly with other professionals. They can facilitate access to resources, medical devices and aids required to restore patient autonomy.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Addressing Healthcare Needs in Older People after Discharge

Proietti¹,

Compagnone²,

Liotta³

2014

AAR

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“…Decreasing readmissions thr-ough better discharge planning (DP) and transitional care is an international priority and many teams are working on solutions to improve this measure of quality (Bauer, Fitzgerald, Haesler, & Manfrin, 2009; Boling, 2009; BOOSTing Care Transitions Resource Room Project Team, 2008; Boutwell, Griffin, Hwu, & Shannon, 2009 March; Bowles et al, 2009; Coleman, Parry, Chahners, & Min, 2006; Graumlich et al, 2009; Jack et al, 2009; Naylor et al, 1999, 2004; Preyde, Macaulay, & Dingwall, 2009; Shepperd et al, 2010). A critical step of the process occurs when the clinical team decides whether or not to refer the patient for post-acute care (PAC) services such as skilled home care, inpatient rehabilitation, or skilled nursing facility care.…”

mentioning

confidence: 99%

“…This study tested the effect of an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports clinicians’ discharge referral decision making by identifying high-risk patients who need a referral for PAC (Bowles .et al, 2008, 2009). The study examined whether alerting hospital case managers about high-risk patients would result in better discharge plans as evidenced by time to first hospital readmission.…”

mentioning

confidence: 99%

Impact of Discharge Planning Decision Support on Time to Readmission Among Older Adult Medical Patients

Bowles

Hanlon

Holland

et al. 2014

Professional Case Management

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Purpose of the Study Hospital clinicians are overwhelmed with the volume of patients churning through the health care systems. The study purpose was to determine whether alerting case managers about high-risk patients by supplying decision support results in better discharge plans as evidenced by time to first hospital readmission. Primary Practice Setting Four medical units at one urban, university medical center. Methodology and Sample A quasi-experimental study including a usual care and experimental phase with hospitalized English-speaking patients aged 55 years and older. The intervention included using an evidence-based screening tool, the Discharge Decision Support System (D2S2), that supports Clinicians′ discharge referral decision making by identifying high-risk patients upon admission who need a referral for post-acute care. The usual care phase included collection of the D2S2 information, but not sharing the Information with case managers. The experimental phase Included data collection and then sharing the results with the case managers. The study compared time to readmission between index discharge date and 30 and 60 days in patients in both groups (usual care vs. experimental). Results After sharing the D2S2 results, the percentage of referral or high-risk patients readmitted by 30 and 60 days decreased by 6% and 9%, respectively, representing a 26% relative reduction in readmissions for both periods. Implications for Case Management Practice Supplying decision support to identify high-risk patients recommended for postacute referral is associated with better discharge plans as evidenced by an increase in time to first hospital readmission. The tool supplies standardized information upon admission allowing more . time to work with high-risk admissions.

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“…2,3 Experts were able to identify 26 characteristics of patients (documented mainly by nurses) that are important to consider when making referral decisions. Through statistical modeling, a six-item risk-screening tool emerged, which provides advice to busy discharge planners about patients who are at risk for poor discharge outcomes and may benefit from postacute care.…”

Section: Data To the Rescuementioning

confidence: 99%