ESDP in Community Hospitals

描述（由申请人提供）：早期识别具有复杂急性期后护理需求的住院患者，可最大限度地缩短设计和实施全面出院计划的时间。学术医疗中心的研究小组的初步工作表明，当医院出院计划（DP）专家及早参与时，及时协调所需的服务，以提高护理的连续性，患者安全和资源利用得到加强。同样，住院时间缩短，患者报告出院后未满足的需求减少。相反，如果在住院早期没有启动DP，患者返回家中时需求未得到满足，再入院率增加。该研究团队已成功开发并实施了一种早期DP决策支持工具（出院计划早期筛查-ESDP），该工具已在学术医疗中心进行了测试。由于特定情况下的特征（如床位大小、教学状况和农村/城市位置）的差异可能会导致预测模型的性能发生变化，因此迫切需要在大多数住院患者接受护理的社区环境中验证ESDP。调查小组的长期研究目标是通过改进DP策略来改善患者安全和成功重返社区，以满足患者日益复杂的急性后护理需求。本研究的目的是确定ESDP在区域社区医院的预测性能。中心假设是，ESDP区分区域社区医院的患者谁会受益于那些谁不会受益于早期DP干预措施的问题和未满足的持续护理需求，生活质量，住院时间，并转介到急性后服务。以质量健康为导向 结果模型是一项比较性、描述性调查研究，将对中西部一家地区社区医院收治的166名成年患者进行方便样本。将在基线时收集ESDP和样本特征。出院后一周，参与者将完成一份问卷，包括出院后问题问卷-英文版和EQ 5-D生活质量测量。住院时间和接受急症后服务的使用情况也将记录在案。描述性统计将总结样本特征并按组描述数据。将使用双样本t检验或Wilcoxon秩和检验对ESDP评分低和高的受试者之间报告的问题和未满足需求的百分比进行比较。将使用Cochran-Armitage趋势检验比较各组（ESDP低分和高分）的EQ-5D维度。将使用双样本t检验和Wilcoxon秩和检验比较两组之间的住院时间和转诊至急性后服务的数量。本研究的预期结果是提供一个标准化的，非常实用的决策支持工具，在区域社区医院使用急需的验证。

DESCRIPTION (provided by applicant): Early identification of hospitalized patients with complex post-acute care needs maximizes the time to design and implement a comprehensive discharge plan. Preliminary work of the research team in academic medical centers shows that when hospital discharge planning (DP) experts are engaged early, the timely coordination of services needed to improve continuity of care, patient safety, and resource use is enhanced. Similarly, length of stay is decreased and patients report fewer unmet needs after discharge. Conversely, when DP is not initiated early in the hospital stay, patients return home with unmet needs and readmissions increase. The study team has successfully developed and implemented an early DP decision support tool (Early Screen for Discharge Planning -ESDP) that has been tested in academic medical centers. Because differences in in- situation-specific characteristics such as bed size, teaching status, and rural/urban location can create variability in the performance of predictive models, there is critical need to validate the ESDP in community settings where most hospitalized patients are cared for. The long range research goal of the investigative team is to improve patient safety and successful reintegration back into the community through improved DP strategies to meet patients' increasingly complex post-acute care needs. The purpose of this study is to determine the predictive performance of the ESDP in regional community hospitals. The central hypothesis is that the ESDP differentiates between patients in regional community hospitals who would benefit from those who would not benefit from early DP intervention as measured by problems and unmet continuing care needs, quality of life, length of stay, and referrals to post-acute services. Guided by the Quality Health Outcomes Model, a comparative, descriptive survey study will be conducted with a convenience sample of 166 adult patients admitted to a regional community hospital in the Midwest. The ESDP and sample characteristics will be collected at baseline. One week after discharge participants will complete a questionnaire consisting of the Problems after Discharge Questionnaire-English Version and the EQ5-D quality of life measure. Length of stay and use of post-acute services received will also be recorded. Descriptive statistics will summarize sample characteristics and describe the data by groups. Comparisons of the percentages of reported problems and unmet needs between participants with low and high ESDP scores will be evaluated using two-sample t or Wilcoxon rank sum tests. The EQ-5D dimensions will be compared between groups (low and high ESDP scores) using Cochran-Armitage trend tests. Hospital length of stay and the number of referrals to post-acute services will be compared between groups using two-sample t and Wilcoxon rank sum tests. The expected outcome of this study is to provide much needed validation of a standardized, highly practical decision support tool for use in regional community hospitals.