Managing postacute hospital care: a case for biopsychosocial needs.
OBJECTIVE
This study aimed to investigate whether, for an identical diagnosis, patients who were transferred to a postacute care (PAC) facility had a higher biopsychosocial complexity than patients who were discharged home.


METHODS
This prospective study employed group comparison that included 166 patients who were consecutively admitted to an acute care internal medicine ward for acute congestive heart failure, pneumonia or exacerbation of chronic obstructive pulmonary disease, and malaise or fall. Patients were evaluated within their first 48 h of stay. Biomedical, functional, quality of life, and case complexity data were collected. Factors associated with a transfer to the PAC facility were identified through logistic regression modeling.


RESULTS
Fifty-eight patients (34.9%) were transferred. In the multivariate analyses, case complexity score [per point: odds ratio (OR)=1.29; 95% CI=1.18-1.41] and nursing workload (OR=1.06; 95% CI=1.01-1.12) were associated with the transfer. At a cutoff point of > or =33, the case complexity score predicted transfer to the PAC facility with a sensitivity of 79% and a specificity of 84% (positive predictive value=73.0%; negative predictive value=88.4%) and correctly classified 83% of the cases.


CONCLUSIONS
Biomedical characteristics alone did not differentiate patients who were transferred versus those who were discharged home, nor did it predict PAC use. This was also true for specific severity scores of cardiac failure and pneumonia as well as for the comorbidity index. Psychosocial parameters were significantly associated to this process as well as a higher nursing workload.
Luthy
Christophe
C
Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.
Cedraschi
Christine
C
Rutschmann
Olivier T
OT
Kossovsky
Michel P
MP
Allaz
Anne-Françoise
AF
D000203:Activities of Daily Living / Q000145:classification; D000208:Acute Disease; D000359:Aftercare / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000534:rehabilitation; D004185:Disability Evaluation; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000453:epidemiology* / Q000534:rehabilitation; D006801:Humans; D007380:Intermediate Care Facilities / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000453:epidemiology* / Q000534:rehabilitation; D011602:Psychophysiologic Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D011788:Quality of Life