Clemens E L
Gerontology Institute, University of Massachusetts at Boston, 02125-3393, USA.
Health Soc Work. 1995 Nov;20(4):254-61. doi: 10.1093/hsw/20.4.254.
Since the advent of diagnosis-related groups (DRGs), advocacy groups have claimed that although hospital discharge planners perceive the discharge planning process as helpful, elderly patients and their families do not. This article explores how the discharge planning process was perceived by 40 discharge planners and 40 family caregivers. Planners greatly overrated caregiver influence and the amount adequacy of information shared about posthospital health care, choice of discharge to home or nursing home, and time to decide. Caregivers perceived that nursing homes were forced on patients by social workers and physicians. DRGs, physicians, and hospital administrators appeared to pressure social workers to coerce mentally competent patients into nursing homes. Excessive concern by hospital staff about patient safety after discharge may override patients' rights to autonomy and self-determination, violating the NASW Code of Ethics. Implications for practice, policy, and future research are discussed.
自诊断相关分组（DRGs）出现以来，倡导团体声称，尽管医院出院计划制定者认为出院计划流程很有帮助，但老年患者及其家属却不这么认为。本文探讨了40位出院计划制定者和40位家庭照顾者对出院计划流程的看法。计划制定者大大高估了照顾者的影响力以及关于出院后医疗保健、选择回家或养老院以及决策时间所共享信息的充分程度。照顾者认为，养老院是由社会工作者和医生强加给患者的。DRGs、医生和医院管理人员似乎向社会工作者施压，迫使有行为能力的患者入住养老院。医院工作人员对出院后患者安全的过度关注可能会凌驾于患者的自主权和自决权之上，这违反了美国社会工作者协会的道德准则。文中还讨论了对实践、政策和未来研究的启示。
