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


METHODS
Quasi-experimental design.


METHODS
Six general hospitals in Belgium.


METHODS
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.


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


METHODS
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.
Steeman
Els
E
Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
Moons
Philip
P
Milisen
Koen
K
De Bal
Nele
N
De Geest
Sabina
S
De Froidmont
Cécile
C
Tellier
Véronique
V
Gosset
Christiane
C
Abraham
Ivo
I
D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D019090:Case Management; D004059:Diffusion of Innovation; D005260:Female; D005851:Geriatric Nursing; D006769:Hospitals, General; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000592:standards*; D010359:Patient Readmission