A professional-patient partnership model of discharge planning with eldershospitalized with heart failure

Despite efforts ro improve the discharge planning process and subsequent ou tcomes, existing mechanisms fail to accurately identify elders' needs for f ollow-up care. Studies report rehospitalization rates ranging from 12 to 50 %. The two aims of this study were to (1) examine the difference in outcome s for elders hospitalized with heart failure and caregivers who participate d in a professional-patient partnership model of discharge planning compare d to those who received the usual discharge planning and (2) examine differ ences in costs associated with hospital readmission and use of the emergenc y room following hospital discharge. A before-and-after nonequivalent contr ol group design was used for this study. Data-were collected from the contr ol and the intervention cohorts before discharge and at 2 weeks and 2 month s postdischarge. One hundred and fifty-eight patient-caregiver dyads comple ted both the predischarge and 2-weeks postdischarge interviews; 140 also co mpleted a 2-month follow up. The average age of elders was 73.7 years; the average age of the caregivers was 58.5 years. The findings indicated that e lders in the intervention cohort felt more prepared to manage care, reporte d more continuity of information about care management and services, felt t hey were in better health, and when readmitted spent fewer days in the hosp ital than the control cohort. Caregivers in the intervention cohort also re ported receiving more information about care management and having a more p ositive reaction to caregiving 2 weeks postdischarge than the control cohor t. Copyright (C) 2000 by W.B. Saunders Company.