Factors to Support Effective Discharge Decision Making

描述：每年有超过1200万的出院转诊 决定是为医疗保险接受者，但没有国家， 根据经验得出的临床指南，以帮助使这些重要的 决策出院转介决策质量为负 受缩短的逗留时间、不一致的评估标准影响， 决策中的专业知识水平和风险承受能力各不相同。这些 这些因素可能会导致弱势长者出院， 昂贵的，糟糕的出院结果。本研究的目的是：（1）捕捉 专家在建立决策支持系统方面的知识， 护士和其他临床医生，同时作出出院转诊决定 对于老年患者，2）比较专家的出院转介率 护士和其他医院临床医生的转诊率， 3）检查专家系统与 临床医生决定转诊或不转诊患者进行随访， 患者出院后的结果。研究的具体目的是：1） 确定支持护士和其他临床医生的因素层次结构， 关于出院后随访转诊的决策， 住院老年人，和2）比较的敏感性和特异性 一个专家决策支持系统与出院转诊决定， 对于老年人，由出院计划专家，护士和其他 临床医生4名国家认可的多学科学者和4名 多学科，临床专家将参与知识渊博的 启发式会议，以阐明应该 在做出出院转介决定时考虑。决定 分析方法将指导使用各种知识的启发 技术.使用层次分析法，专家将加权 一系列因素在决定是否将一个 特定患者进行出院后随访。专家系统将 放入专家外壳中，使用以下案例研究进行验证和测试： 住院老年人来自一个正在进行的对照组， 两项已完成的NINR资助的临床试验。确定出院转诊率 将专家系统与临床医生和专家的转诊进行比较 由专家确定的老年人的比率和出院后结果 转诊系统将与老年人确定的 系统不需要转介。该研究具有重要的临床意义 影响研究结果将确定并提供以下知识： 专家，以规范和方便识别病人的需要， 出院后随访。结果还可以提高质量和一致性 减少转诊决定所需的时间， 与未满足的出院后需求相关的不良结果相关的成本。

DESCRIPTION: Each year more than 12 million hospital discharge referral decisions are made for Medicare recipients, yet there are no national, empirically derived clinical guidelines to assist in making these important decisions. The quality of discharge referral decision-making is negatively affected by shortened lengths of stay, inconsistent assessment criteria, and varying levels of expertise and risk tolerance in decision-making. These factors may result in the discharge of vulnerable elders who will experience costly, poor discharge outcomes. The study's purposes are: 1) to capture the knowledge of experts in the creation of a decision support system to be used by nurses and other clinicians while making hospital discharge referral decisions for older patients, 2) to compare the discharge referral rates of the expert system to the referral rates of nurses and other hospital clinicians and experts, and 3) to examine the relationship of the expert system's and clinicians' decisions to refer or not to refer patients for follow up with patients' post-discharge outcomes. The specific aims of the study are: 1) to identify a hierarchy of factors to support nurses and other clinicians' decision making regarding referrals for post-discharge follow-up for hospitalized older adults, and 2) to compare the sensitivity and specificity of an expert decision support system with hospital discharge referral decisions, for older adults, made by discharge planning experts, nurses and other clinicians. Four nationally recognized multidisciplinary scholars and four multidisciplinary, clinical experts would participate in knowledgeable elicitation sessions to explicate the hierarchy of factors that should be considered when making hospital discharge referral decisions. A decision analysis methodology will guide the use of a variety of knowledge elicitation techniques. Using the analytic hierarchy process, experts will weight the importance of a range of factors in relation to the decision to refer a particular patient for post-discharge follow-up. The expert system will be placed into an expert shell, validated and tested using case studies of hospitalized older adults derived from the control groups of one ongoing and two completed NINR funded clinical trials. Discharge referral rates identified by the expert system will be compared with clinicians' and experts' referral rates and post-discharge outcomes of older adults identified by the expert system for referral will be compared to the older adults identified by the system as not needing a referral. The research has important clinical implications. Study findings will identify and make available the knowledge of experts to standardize and facilitate the identification of patients in need of post-discharge follow-up. Results may also improve the quality and consistency of referral decisions, reduce the time required for evaluation, and decrease the costs associated with poor outcomes related to unmet post-discharge needs.