Authors: Diane E Holland, PhD, RN, Clinical Nurse Researcher, Mayo Clinic, Eisenberg, Rochester, MN; George J Knafl, PhD, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kathryn H Bowles, PhD, RN, FAAN, Associate Professor, Biobehavioral Health Sciences Division, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
J Clin Nurs. 2013 Oct;22(19-20):2696-703. doi: 10.1111/j.1365-2702.2012.04221.x. Epub 2012 Aug 21.
The purpose of the study was to describe the ability of an evidence-based discharge planning (DP) decision support tool to identify and prioritise patients appropriate for early DP intervention. Specifically, we aimed to determine whether patients with a high Early Screen for Discharge Planning (ESDP) score report more problems and continuing care needs in the first few weeks after discharge than patients with low ESDP scores.
Improved methods are needed to efficiently and accurately identify hospitalised patients at risk of complex discharge plans.
A descriptive cross-sectional study was designed using a quality health outcomes framework.
The ESDP was administered to 260 adults hospitalised in an academic health centre who returned home after discharge. Problems and continuing care needs were self-reported on the Problems After Discharge Questionnaire - English Version, mailed 6-10 days after discharge.
Patients with high ESDP scores reported significantly more problems [mean, 16·3 (standard deviation ±8·7)] than those with low scores [12·2 (±8·4)]. Within the Problems After Discharge Questionnaire subscales, patients with high ESDP scores reported significantly more problems with personal care, household activities, mobility and physical difficulties than patients with low screen scores. Significantly more of the patients with a high ESDP score received consults to a Discharge Planner and referrals for postacute services than patients with low screen scores.
The ESDP is effective as a decision support tool in identifying patients to prioritise for early DP intervention.
Use of an evidence-based DP decision support tool minimises biases inherent in decision-making, promotes efficient use of hospital DP resources, and improves the opportunity for patients to access community resources they need to promote successful recovery after hospitalisation.
本研究的目的是描述一种基于证据的出院计划（DP）决策支持工具识别和优先考虑适合早期 DP 干预的患者的能力。具体来说，我们旨在确定 ESDP 评分高的患者在出院后几周内报告的问题和持续护理需求是否多于 ESDP 评分低的患者。
需要改进方法，以有效地、准确地识别有复杂出院计划风险的住院患者。
本研究采用质量健康结果框架设计了一项描述性的横断面研究。
对在学术医疗中心住院并在出院后返回家中的 260 名成年人进行 ESDP 评估。出院后 6-10 天，通过邮寄的方式让患者自行报告《出院后问题问卷-英文版》中报告的问题和持续护理需求。
ESDP 评分高的患者报告的问题明显多于评分低的患者[平均值，16.3（标准差±8.7）]。在《出院后问题问卷》子量表中，ESDP 评分高的患者在个人护理、家务活动、活动能力和身体困难方面报告的问题明显多于评分低的患者。ESDP 评分高的患者中，接受出院计划师咨询和转介到急性后期服务的患者明显多于评分低的患者。
ESDP 作为一种决策支持工具，可有效识别需要优先进行早期 DP 干预的患者。
使用基于证据的 DP 决策支持工具可最大限度地减少决策过程中的固有偏见，促进医院 DP 资源的有效利用，并提高患者获得所需社区资源的机会，以促进其在出院后的康复。
