title: Efficacy of early clinical evaluation in predicting direct home discharge of elderly patients after hospitalization in internal medicine.
abstract: OBJECTIVE
  Early evaluation of direct home discharge (DHD) after hospitalization of elderly patients is important to organize discharge planning quickly. Many scores, scales, and indices have been developed to improve discharge planning. Is clinical judgment better than functional status, comorbidity, or cognitive function scales in predicting DHD of elderly patients after hospitalization?
  
  
  METHODS
  Ninety-seven patients, aged 75 years or older, admitted from the emergency department to an internal medicine department in a French teaching hospital between December 1, 2006 and May 1, 2007, were enrolled prospectively in the study. Demographic, clinical, and laboratory characteristics and functional status, comorbidity, and cognitive function scales were determined. The primary outcome was the percentage of correct discharge prediction made by junior and senior doctors within the first 48 hours upon admission. Univariate analysis and logistic regression were assessed to determine predictive variables of patients' discharge.
  
  
  RESULTS
  Junior and senior doctors obtained correct prediction in 74.2% and 73.2% of cases, respectively (P > 0.99). Activities of daily living, instrumental activities of daily living, and duration of hospitalization were predictive of DHD (95% confidence interval [CI] -6.1 to 0.2, P = 0.037; 95% CI -2.1 to 9.9, P = 0.003; 95% CI -3 to 9.1, P = 0.0001, respectively) in the univariate analysis. Instrumental activities of daily living was an independent predictive variable of patients' discharge in a logistic regression. No difference between clinical evaluation and the use of an independent predictive variable regarding the prediction of DHD was found.
  
  
  CONCLUSIONS
  Early clinical evaluation is as effective as the use of functional status scales to predict DHD of hospitalized elderly patients.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Université Paris XIII, Service de Médecine Interne, Hôpital Avicenne, Bobigny, France. nicolas.gambier@ch-stdenis.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Gambier
authors.forename: Guy
authors.initials: G
authors.lastname: Simoneau
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bihry
authors.forename: Véronique
authors.initials: V
authors.lastname: Delcey
authors.forename: Karine
authors.initials: K
authors.lastname: Champion
authors.forename: Pierre
authors.initials: P
authors.lastname: Sellier
authors.forename: Irène
authors.initials: I
authors.lastname: Jarrin
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Bergmann
authors.forename: Stéphane
authors.initials: S
authors.lastname: Mouly
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006748:Hospital Departments; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine; D007902:Length of Stay / Q000639:trends*; D008297:Male; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies