DISCHARGE PLANNING DECISION-MAKING BY HOSPITALIZED-PATIENTS

Although studies have examined decision making in discharge planning, few have studied the decision-making process from the patient's perspe ctive. Using structured cases, this pilot study examined patients' dec isions for discharge planning. Four variables were manipulated to crea te 24 unique cases. These variables included patient living situation, personal assistance needs, home assistance needs, and complexity of m edication regime. Respondents rank ordered the appropriateness of four discharge options (i.e., outpatient clinic, housekeeping/chore, home health nursing, and nursing home care) for each case. Eighty chronical ly ill hospitalized patients from two VA hospitals served as subjects. Patient living arrangement, home assistance needs, and personal assis tance needs had strong relationships with the perceived appropriatenes s of outpatient and nursing home care. When patient status was good, n ursing home care was clearly an inappropriate solution from the patien ts' perspective. Outpatient care was ranked as less appropriate when p atient status deteriorated. The only significant association with home health care was personal assistance needs. Medication complexity had no significant association with the four discharge options.