title: Demand and predictors for post-discharge medical counseling in home care patients: a prospective cohort study.
abstract: BACKGROUND
  Post-discharge care is challenging due to the high rate of adverse events after discharge. However, details regarding post-discharge care requirements remain unclear. Post-discharge medical counseling (PDMC) by telephone service was set-up to investigate its demand and predictors.
  
  
  METHODS
  This prospective study was conducted from April 2011 to March 2012 in a tertiary referral center in northern Taiwan. Patients discharged for home care were recruited and educated via telephone hotline counseling when needed. The patient's characteristics and call-in details were recorded, and predictors of PDMC use and worsening by red-flag sign were analyzed.
  
  
  RESULTS
  During the study period, 224 patients were enrolled. The PDMC was used 121 times by 65 patients in an average of 8.6 days after discharge. The red-flag sign was noted in 17 PDMC from 16 patients. Of the PDMC used, 50% (n = 60) were for symptom change and the rest were for post-discharge care problems and issues regarding other administrative services. Predictors of PDMC were underlying malignancy and lower Barthel index (BI). On the other hand, lower BI, higher adjusted Charlson co-morbidity index (CCI), and longer length of hospital stay were associated with PDMC and red-flag sign.
  
  
  CONCLUSIONS
  Demand for PDMC may be as high as 29% in home care patients within 30 days after discharge. PDMC is needed more by patients with malignancy and lower BI. More focus should also be given to those with lower BI, higher CCI, and longer length of hospital stay, as they more frequently have red flag signs.
authors.affiliation: Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Shih-Tan
authors.initials: ST
authors.lastname: Ding
authors.forename: Chuan-Lan
authors.initials: CL
authors.lastname: Wang
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Huang
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.forename: Yu-Tzu
authors.initials: YT
authors.lastname: Tseng
authors.forename: Chun-Ta
authors.initials: CT
authors.lastname: Huang
authors.forename: Nin-Chieh
authors.initials: NC
authors.lastname: Hsu
authors.forename: Yu-Feng
authors.initials: YF
authors.lastname: Lin
authors.forename: Hung-Bin
authors.initials: HB
authors.lastname: Tsai
authors.forename: Ming-Chin
authors.initials: MC
authors.lastname: Yang
authors.forename: Wen-Je
authors.initials: WJ
authors.lastname: Ko
mesh_terms: D000368:Aged; D003376:Counseling / Q000706:statistics & numerical data* / Q000600:supply & distribution; D018450:Disease Progression; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D055986:Vital Signs