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Observational Study
. 2018 Feb 13;18(1):111.
doi: 10.1186/s12913-018-2897-0.

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

Antoinette Conca  1   2 , Angela Gabele  3 , Barbara Reutlinger  3 , Philipp Schuetz  4 , Alexander Kutz  4 , Sebastian Haubitz  5 , Lukas Faessler  4   6 , Marcus Batschwaroff  4 , Ursula Schild  4 , Zeljka Caldara  4 , Katharina Regez  4 , Susanne Schirlo  4 , Gabi Vossler  4 , Timo Kahles  7 , Krassen Nedeltchev  7 , Anja Keller  8 , Andreas Huber  9 , Sabina De Geest  10 , Ulrich Buergi  11 , Petra Tobias  11 , Martine Louis Simonet  12 , Beat Mueller  4 , Petra Schäfer-Keller  13
Affiliations
Observational Study

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

Antoinette Conca et al. BMC Health Serv Res. .

Abstract

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.

Trial registration: ClinialTrials.gov Identifier, NCT01768494 .

Keywords: Diagnostic accuracy; Discharge planning; Post-acute care discharge score; Post-acute care facilities; Screening tool; Social worker referral.

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Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Board of the Canton of Aargau approved the study and waived the need for informed consent (EK 2012/059) as this was an observational quality control study.

Consent for publication

Not applicable.

Competing interests

Drs Schutz and Mueller received support from Thermos Fischer Scientific. All other authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of recruitment of medical and neurological patients (February – October 2013)
Fig. 2
Fig. 2
Receiver operator characteristic curve and AUC analysis of the PACD day-1 in medical patients
Fig. 3
Fig. 3
Receiver operator characteristic curve and AUC analysis of PACD day-3 in medical patients
Fig. 4
Fig. 4
Receiver operator characteristic curve and AUC analysis of the adapted PACD day-1 in neurological patients
Fig. 5
Fig. 5
Receiver operator characteristic curve and AUC analysis of PACD day-3 in neurological patients
See this image and copyright information in PMC

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