Predictive validity of the BRASS index in screening patients with post-discharge problems. Blaylock Risk Assessment Screening Score.
BACKGROUND
Discharge planning is a nursing intervention that aims to ensure continuity of care; it consists of several steps of which selecting patients in need of it is the first one. The Blaylock Risk Assessment Screening Score (BRASS) index is a risk screening instrument which can be used early after admission to identify those patients in need of discharge planning.


OBJECTIVE
To test the predictive validity of the BRASS index in screening patients with post-discharge problems.


METHODS
Prospective longitudinal design with prediction instrument measured at admission, and outcomes measured at discharge and 7 and 30 days after discharge.


METHODS
length of stay, discharge destination, status after discharge.


METHODS
BRASS index, Problems after discharge Questionnaire, Nottingham Health Profile, COOP/WONCA charts.


METHODS
503 elderly patients were screened at admission with the BRASS index. Length of stay and discharge destination were measured at discharge in these same patients. Outcomes after discharge were gathered only in patients who were discharged home and with length of stay of more than 3 days (n=226); outcomes were measured by postal questionnaires at day 7 and day 30 after discharge.


RESULTS
patients identified by the BRASS index as high risk are frequently not discharged home and have a longer length of stay. The BRASS scores correlate significantly with the outcome scores after discharge: the higher the BRASS score, the higher the difficulty score after discharge on all domains. However, the sensitivity of the BRASS index is rather low.


CONCLUSIONS
This study demonstrates that the BRASS index is a good predictor instrument for indicating patients who are not discharged home, that the BRASS scores correlate significantly with problems experienced after discharge and that it has high specificity to predict patients with problems after discharge. Clinical use, however, is limited due to the low sensitivity. The BRASS index is a promising case-finding instrument for discharge planning, but needs further development.
Mistiaen
P
P
Research Centre Primary-Secondary Health Care, VU Hospital, Amsterdam, The Netherlands. pmistiaen@algemeen.azl.nl
Duijnhouwer
E
E
Prins-Hoekstra
A
A
Ros
W
W
Blaylock
A
A
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D008297:Male; D009730:Nursing Assessment / Q000379:methods* / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires