MANAGEMENT OF ALTERNATE LEVEL OF CARE PATIENTS USING A COMPUTERIZED DATABASE

The term ''alternate level of care'' (ALC) refers to the status of hos pitalized patients who are no longer acutely ill but cannot be dischar ged because posthospital plans are not yet in place. ALC is a major pr oblem for patients, families, and hospitals. This article describes th e experiences of an urban teaching hospital with ALC and the developme nt of a computerized database to better manage the ALC population. Amo ng the findings were that age, waiting for a nursing home placement, f amily-related discharge problems, and pending Medicaid eligibility all significantly contributed to length of stay beyond the acute phase of the illness. Using these data, the hospital developed an innovative p rogram in which the preparation of Medicaid applications was transferr ed from the Department of Finance to the Department of Social Work Ser vices.