A PREDICTION RULE FOR THE USE OF POSTDISCHARGE MEDICAL-SERVICES

OBJECTIVE: To develop and validate a prediction rule screening instrum ent, easily incorporated into the routine hospital admission assessmen t, that could facilitate discharge planning by identifying patients at the time of admission who are most likely to need postdischarge medic al services. DESIGN: prospective cohort study with separate phases for prediction rule development and validation. SETTING: Urban teaching h ospital. PATIENTS/PARTICIPANTS: General medical service patients, 381 in the derivation phase and 323 in the validation phase, who provided self-reported medical history, health status, and demographic data as a part of their admission nursing assessment, and were subsequently di scharged alive. MEASUREMENTS AND MAIN RESULTS: Use of postdischarge me dical services such as visiting nurse or physical therapy, medical equ ipment, or placement in a rehabilitation or longterm care facility was determined. A prediction rule based on a patient's age and Medical Ou tcomes Study 36-Item Short Form Health Survey (SF-36) physical functio n and social function scores stratified patients with regard to their risk of using postdischarge medical services. In the validation set, t he rate of actual postdischarge medical service use was 15% (15 of 97) , 36% (39 of 107), and 58% (57 of 98) among patients characterized by the prediction rule as being at ''low'', ''intermediate,'' and ''high' ' risk of using postdischarge medical services, respectively. CONCLUSI ONS: This prediction rule stratified general medical patients with reg ard to their likelihood of needing discharge planning to arrange for p ostdischarge medical services. Further research is necessary to determ ine whether prospective identification of patients likely to need disc harge planning will make the hospital discharge planning process more efficient.