Hospital cost containment efforts, such as in Maryland, are encouraging reductions in length of stay through per case payment and are denying payment for inpatient days judged inappropriate. As inpatient stays become shorter, more patients may require more intensive discharge planning to aid in their recovery at home, instead of being hospitalized or institutionalized. Although the importance of discharge planning for assuring the continuity of patient care after discharge has long been recognized, the relative effectiveness of various discharge planning patterns have not been examined. The overall objective is to evaluate the effectiveness of alternative strategies for discharge planning;
the specific aims of the research are: I. Identify characteristics of patients who receive formal versus informal discharge planning and assess the extent to which their needs are being met. II. Determine the relationship of early versus late identification and assessment by a single provider versus interdisciplinary groups on the extent to which needs are identified, needs are met, and whether delays occur. III. Identify risk factors for those who fail to return to prior functional levels, develop complications, or have unscheduled readmissions in contrast to those who experience better outcome. This study will follow a systematic random sample of patients age 60 and over admitted to the medical/surgical services of five area hospitals, who remain hospitalized for at least 4 days and are discharged home (N=1000). These hospitals were chosen because they cover a spectrum of approaches to discharge planning. Patients with stays under 4 days are excluded because they are more likely to be admitted for tests or minor procedures and require little discharge planning. Information will be captured at discharge on formal discharge planning provided, discharge status of patient, and information obtained on the appropriateness of the last four days of stay. At 2 weeks and 3 months post-discharge, information will be obtained by patient interview on perceived needs, needs met and when, knowledge of care requirements, compliance with medical regimen, complications, functional status, and utilization of ambulatory and inpatient services. This study is expected to provide previously unavailable information on the effectiveness of alternative organizational approaches to discharge planning, and to provide insights into the contribution of discharge planning to outcomes of care.
