Key result
Adding self-care index to PACD score improves post-acute care discharge prediction, raising medical AUC to 0.83.
Why the study?
Reducing delays in hospital discharge requires improved early identification of patients needing post-acute care, and adding self-care ability assessment may enhance prognostic accuracy.
Does adding a self-care index to the post-acute care discharge score improve prognostic accuracy for predicting discharge to a post-acute care facility in adult medical and neurological inpatients?
Cohort (n=1,744)
No
Does adding a self-care index to the post-acute care discharge score improve prognostic accuracy for predicting discharge to a post-acute care facility in adult medical and neurological inpatients?
Odds Ratio: 0.897 (95% CI 0.864–0.93)
p-value: p=<0.001
Adding an intrahospital self-care ability assessment to the post-acute care discharge score significantly improves the prediction of which patients will require discharge to a post-acute care facility.
BACKGROUND: Reducing delays in hospital discharge is important to improve transition processes and reduce health care costs. The recently proposed post-acute care discharge score focusing on the self-care abilities before hospital admission allows early identification of patients with a need for post-acute care. New limitations in self-care abilities identified during hospitalization may also indicate a risk. Our aim was to investigate whether the addition of the post-acute care discharge score and a validated self-care instrument would improve the prognostic accuracy to predict post-acute discharge needs in unselected medical inpatients. METHODS: We included consecutive adult medical and neurological inpatients. Logistic regression models with area under the receiver operating characteristic curve were calculated to study associations of post-acute discharge score and self-care index with post-acute discharge risk. We calculated joint regression models and reclassification statistics including the net reclassification index and integrated discrimination improvement to investigate whether merging the self-care index and the post-acute discharge score leads to better diagnostic accuracy. RESULTS: Out of 1342 medical and 402 neurological patients, 150 (11.18%) and 94 (23.38%) have reached the primary endpoint of being discharged to a post-acute care facility. Multivariate analysis showed that the self-care index is an outcome predictor (OR 0.897, 95%CI 0.864-0.930). By combining the self-care index and the post-acute care discharge score discrimination for medical (from area under the curve 0.77 to 0.83) and neurological patients (from area under the curve 0.68 to 0.78) could be significantly improved. Reclassification statistics also showed significant improvements with regard to net reclassification index (14.2%, p<0.05) and integrated discrimination improvement (4.83%, p<0.05). CONCLUSIONS: Incorporating an early assessment of patients' actual intrahospital self-care ability to the post-acute care discharge score led to an improved prognostic accuracy for identifying adult, medical and neurological patients at risk for discharge to a post-acute care facility.
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Koch et al. (2019) conducted a cohort in Medical and neurological inpatients (n=1,744). Self-care index (SPI) combined with post-acute care discharge score (PACD) vs. PACD alone was evaluated on Discharge to a post-acute care (PAC) facility (OR 0.897, 95% CI 0.864-0.930, p=<0.001). Adding the self-care index to the post-acute care discharge score significantly improved discrimination for predicting discharge to a post-acute care facility in medical (AUC 0.77 to 0.83) and neurological patients (AUC 0.68 to 0.78).
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