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International Journal for Quality in Health Care Advance Access published online on July 22, 2006
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzl026
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© The Author 2006. Published by Oxford University Press on behalf of International Society for Quality in Health Care; all rights reserved
Accepted June 18, 2006

Article

Implementation of discharge management for geriatric patients at risk of readmission or institutionalization

Els Steeman 1, Philip Moons 2 *, Koen Milisen 2, Nele De Bal 1, Sabina De Geest 3, Cécile De Froidmont 4, Véronique Tellier 4, Christiane Gosset 4, and Ivo Abraham 5

1 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium
2 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium; University Hospitals of Leuven, Leuven, Belgium
3 Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Belgium; Institute of Nursing Science, University of Basel, Basel, Switzerland
4 Public Health and Epidemiology, University of Liège, Liège, Belgium
5 University of Pennsylvania, School of Nursing, Center for Health Outcomes and Policy Research; The Wharton School of Business, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA; Matrix45, Earlysville, VA, USA

* To whom correspondence should be addressed.
Philip Moons, E-mail: philip.moons{at}med.kuleuven.be


  Abstract

Objective. To evaluate whether implementation of discharge management by trained social workers or nurses reduces hospital readmissions and institutionalizations of geriatric patients in a real-world setting.

Design. Quasi-experimental design.

Setting. Six general hospitals in Belgium.

Participants. A representative sample of 824 patients, 355 of whom were assigned to the experimental group receiving comprehensive discharge management and 469 to the control group receiving usual care. Inclusion criteria were patients admitted to a geriatric, rehabilitation, or internal medicine ward, not residing in a nursing home, and showing risk of readmission or institutionalization on admission in the hospital.

Intervention. In-hospital discharge planning according to a case management protocol allowing for adjustment to participating hospitals’ case mix and patients’ and families’ specific needs.

Main outcome measures. Hospital readmission within 15 and 90 days post discharge; institutionalization at discharge and within 15 and 90 days post discharge.

Results. Discharge management resulted in fewer institutionalizations (n = 53; 14.9%) compared with usual care (n = 130; 23.7%) (adjusted odds ratio = 0.47; CI 95% = 0.31-0.70). Readmission rates between the intervention and usual care group were not significantly different.

Conclusions. This implementation project showed that a discharge planning intervention can reduce institutionalization rates of elderly patients in real-life settings.

Keywords: case management, elderly, geriatric nursing, patient discharge.
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