Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada.
Goodman School of Business, Brock University, St. Catharines, Ontario, Canada.
J Am Med Dir Assoc. 2023 Sep;24(9):1327-1333. doi: 10.1016/j.jamda.2023.02.104. Epub 2023 Mar 27.
The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database.
Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC.
Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database.
ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model.
Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06-1.43); OR = 1.28, (1.03-1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83-36.04); OR = 6.22, (4.75-8.15)]. AC patients had bariatric [OR = 7.16, (3.45-14.83)], behavioral [OR = 1.89, (1.22-2.91)], infection (isolation) [OR = 2.31, (1.63-3.28)], and feeding [OR = 6.38, (1.82-22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge.
Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges.
本研究旨在利用安大略省等待时间信息系统（WTIS）数据库收集的数据，确定增加 ALC 患者长期延迟出院几率的因素。
利用尼亚加拉健康 WTIS 数据库进行回顾性队列研究。WTIS 包括被指定为 ALC 的任何尼亚加拉健康场所入院的个体。
样本由 16429 名在 2014 年 9 月至 2019 年 9 月期间在尼亚加拉健康医院接受护理的 ALC 患者组成，并记录在 WTIS 数据库中。
30 天或以上的 ALC 指定被用作长期延迟出院的阈值。本研究使用二元逻辑回归模型分析性别、年龄、入院来源和出院目的地以及需求/障碍要求，以评估在存在每种变量的情况下，急性护理（AC）和康复后护理（PAC）患者发生长期延迟出院的可能性。样本量计算和接收者操作特征曲线用于验证回归模型的有效性。
总体而言，10.2%的样本被认为是长期 ALC 患者。AC 和 PAC 长期 ALC 患者更有可能是男性[比值比（OR）=1.23，（1.06-1.43）；OR=1.28，（1.03-1.60）]，出院目的地为长期护理床位[OR=28.68，（22.83-36.04）；OR=6.22，（4.75-8.15）]。AC 患者有肥胖[OR=7.16，（3.45-14.83）]、行为[OR=1.89，（1.22-2.91）]、感染（隔离）[OR=2.31，（1.63-3.28）]和喂养[OR=6.38，（1.82-22.30）]障碍阻碍出院。PAC 患者没有明显的阻碍患者出院的障碍。
将重点从 ALC 患者的指定转移到短期与长期 ALC 患者，使本研究能够专注于不成比例地影响延迟出院的患者亚组。了解除临床因素外，特殊患者需求的重要性，可以帮助医院更好地准备预防延迟出院。
