title: Research changes a health care delivery system: a biopsychosocial approach to predicting resource utilization in hospital care of the frail elderly.
abstract: The social work department of a large New York City teaching hospital has conducted practice research studies over the past five years to better improve the early identification of high risk elderly patients. A recent prospective study is presented of the relationship between functional capacity and discharge status/length of stay, the results of which directly led to a change in the inpatient delivery system. A sample of 250 randomly selected patients, 65 years or older, selected upon admission, were tested using the Katz ADL, the IADL and the Short Portable Mental Status Questionnaire (PMSQ) to distinguish those patients likely to remain hospitalized beyond medical necessity. Results of a logistic regression indicate that low functional capacity patients (IADL: Wald = 5.6; P < .02) were likely to remain beyond medical necessity. The model predicted group membership correctly 90.6% of the time. These findings have led the medical center to develop an acute care geriatric unit in cooperation with an affiliated nursing home.
authors.affiliation: Long Island Jewish Medical Center, Department of Social Work Services, New Hyde Park, NY 11040, USA.
authors.forename: B D
authors.initials: BD
authors.lastname: Rock
authors.forename: M
authors.initials: M
authors.lastname: Goldstein
authors.forename: M
authors.initials: M
authors.lastname: Harris
authors.forename: P
authors.initials: P
authors.lastname: Kaminsky
authors.forename: E
authors.initials: E
authors.lastname: Quitkin
authors.forename: C
authors.initials: C
authors.lastname: Auerbach
authors.forename: N
authors.initials: N
authors.lastname: Beckerman
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006302:Health Services Research; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D016743:Mental Competency; D011237:Predictive Value of Tests