Early Screen for Discharge Planning in Community Hospitals

Validating Discharge Planning Decision Support in a Regional Community Hospital

The purpose of this study is to determine the predictive performance of the Early Screen for Discharge Planning (ESDP) tool in a regional community hospital. The central hypothesis is that the ESDP differentiates between patients in a regional community hospital who would benefit from those who would not benefit from early discharge-planning intervention as measured by problems and unmet continuing care needs, quality of life, length of stay, and referrals to post-acute services.

Study Overview

• Status: Completed
• Conditions: Hospitalization
• Intervention / Treatment: Other: Early Screen for Discharge Planning

Detailed Description

Patients who are hospitalized for medical or surgical reasons who consent to the study will be screened within 24 hours of hospital admission using the Early Screen for Discharge Planning (ESDP). The ESDP is a four-item screening tool used to determine on admission which patients are likely to have complex discharge plans and could benefit from early engagement of discharge planning personnel. The ESDP yields a total score, and those with a score of 10 or greater are considered to have a "high score" and likely to have a complex discharge plan. Those with a score of 9 or below have a "low score". The ESDP screen has been proven to be valid in large academic medical centers. This study will determine if the screen performs with the same validity in a small community hospital.

• Study Type: Observational
• Enrollment (Actual): 225

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Eau Claire, Wisconsin, United States, 54703
      • Mayo Clinic Health System - Eau Claire

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

The study targets adults hospitalized for a variety of medical and surgical conditions in a rural regional community hospital that is part of a large health system in the Midwest. The sample will be limited to adults who are returning home in the community, because the investigators are primarily interested in the problems and unmet needs encountered after discharge during the recovery period at home. To enhance the generalizability of the results, the sample will be stratified based on 2010 national estimates of age categories for hospitalized adults.

Description

Inclusion Criteria:

• 18 years or older
• Able to read and speak English
• Returning home in the community after discharge

Exclusion Criteria:

• Discharged to facility care
• Pregnant females

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Control
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
High ESDP Score; Patients with 10 or greater score on the Early Screen for Discharge Planning at the time of admission.	Other: Early Screen for Discharge Planning; This screen is completed by a study coordinator within 24 hours of patient admission to the hospital. The screen measures four variables available from routine hospital admission clinical data (walking limitation, age, living alone prior to admission, and level of disability) that exhibit high sensitivity and specificity (AUC's were .82 and.84) in identifying patients who should receive targeted attention from a DP expert.
Low ESDP Score; Patients with 9 or lower score on the Early Screen for Discharge Planning at the time of admission.	Other: Early Screen for Discharge Planning; This screen is completed by a study coordinator within 24 hours of patient admission to the hospital. The screen measures four variables available from routine hospital admission clinical data (walking limitation, age, living alone prior to admission, and level of disability) that exhibit high sensitivity and specificity (AUC's were .82 and.84) in identifying patients who should receive targeted attention from a DP expert.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of problems reported after discharge, measured by the Problems After Discharge Questionnaire - English Version (PADQ-E)	A problem is defined as any worry, limitation, concern, or difficulty reported by the patient. The Problems After Discharge Questionnaire - English Version measures important patient factors often overlooked that contribute to poor post-acute recovery experience which are recognized as important factors likely to impact readmission.	1 week after hospital discharge

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of unmet needs reported after discharge, measured by the Problems After Discharge Questionnaire - English Version (PADQ-E)	An unmet need is a need for help identified by the patient that is reported to be inadequately met. The Problems After Discharge Questionnaire - English Version measures important patient factors often overlooked that contribute to poor post-acute recovery experience which are recognized as important factors likely to impact readmission.	1 week after hospital discharge
Quality of life, measured by the EuroQoL-5D	The EuroQoL-5D (EQ-5D) is a standardized instrument for use as a measure of health out-come. Applicable to a wide range of health conditions and treatments, it provides a simple descriptive profile and a single index value for health status that can be used in the clinical and economic evaluation of health care.	1 week after hospital discharge

Collaborators and Investigators

• Sponsor: Mayo Clinic
• Collaborators: Agency for Healthcare Research and Quality (AHRQ)
• Investigators: Principal Investigator: Diane E. Holland, PhD, RN, Mayo Clinic

Study record dates

Study Major Dates

• Study Start: June 1, 2014
• Primary Completion (Actual): May 1, 2015
• Study Completion (Actual): May 1, 2015

Study Registration Dates

• First Submitted: April 16, 2014
• First Submitted That Met QC Criteria: April 16, 2014
• First Posted (Estimate): April 21, 2014

Study Record Updates

• Last Update Posted (Estimate): May 21, 2015
• Last Update Submitted That Met QC Criteria: May 20, 2015
• Last Verified: May 1, 2015

More Information

Terms related to this study

• Keywords: Decision Support; Discharge Planning
• Other Study ID Numbers: 14-002495