Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process
ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team m...
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| Veröffentlicht in: | Canadian journal on aging 2019-03, Vol.38 (1), p.90-99 |
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| container_title | Canadian journal on aging |
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| creator | Koskas, Pierre Pons-Peyneau, Cécile Romdhani, Mouna Houenou-Quenum, Nadège Galleron, Sandrine Drunat, Olivier |
| description | ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs. |
| doi_str_mv | 10.1017/S0714980818000442 |
| format | Article |
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We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.</description><identifier>ISSN: 0714-9808</identifier><identifier>EISSN: 1710-1107</identifier><identifier>DOI: 10.1017/S0714980818000442</identifier><identifier>PMID: 30404681</identifier><language>eng</language><publisher>Canada: Cambridge University Press</publisher><subject>Activities of daily living ; Age ; Caregivers ; Clinical decision making ; Dementia ; Discharge ; Discharge planning ; Education ; Experts ; Frailty ; Geriatrics ; Home health care ; Hospitalization ; Institutionalization ; Kappa coefficient ; Medical decision making ; Needs assessment ; Nursing homes ; Older people ; Patient compliance ; Patients ; Refusal ; Regression analysis ; Social isolation ; Social problems ; Sociodemographics ; Symptoms ; Teams ; Treatment refusal ; Variables</subject><ispartof>Canadian journal on aging, 2019-03, Vol.38 (1), p.90-99</ispartof><rights>Copyright © Canadian Association on Gerontology. Droit d'auteur: l'Association canadienne de gé</rights><rights>Copyright © Canadian Association on Gerontology 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-33414b04d9f9d23b87624da4d376ca1157724d8f041e4a44fa3493b8e43282323</citedby><cites>FETCH-LOGICAL-c417t-33414b04d9f9d23b87624da4d376ca1157724d8f041e4a44fa3493b8e43282323</cites><orcidid>0000-0002-8379-2087</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27321,27901,27902,33751</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30404681$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koskas, Pierre</creatorcontrib><creatorcontrib>Pons-Peyneau, Cécile</creatorcontrib><creatorcontrib>Romdhani, Mouna</creatorcontrib><creatorcontrib>Houenou-Quenum, Nadège</creatorcontrib><creatorcontrib>Galleron, Sandrine</creatorcontrib><creatorcontrib>Drunat, Olivier</creatorcontrib><title>Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process</title><title>Canadian journal on aging</title><addtitle>Can J Aging</addtitle><description>ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.</description><subject>Activities of daily living</subject><subject>Age</subject><subject>Caregivers</subject><subject>Clinical decision making</subject><subject>Dementia</subject><subject>Discharge</subject><subject>Discharge planning</subject><subject>Education</subject><subject>Experts</subject><subject>Frailty</subject><subject>Geriatrics</subject><subject>Home health care</subject><subject>Hospitalization</subject><subject>Institutionalization</subject><subject>Kappa coefficient</subject><subject>Medical decision making</subject><subject>Needs assessment</subject><subject>Nursing homes</subject><subject>Older people</subject><subject>Patient compliance</subject><subject>Patients</subject><subject>Refusal</subject><subject>Regression analysis</subject><subject>Social isolation</subject><subject>Social problems</subject><subject>Sociodemographics</subject><subject>Symptoms</subject><subject>Teams</subject><subject>Treatment refusal</subject><subject>Variables</subject><issn>0714-9808</issn><issn>1710-1107</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><sourceid>BHHNA</sourceid><recordid>eNplkU1LxDAQhoMoun78AC9S8OKlOtOMTeJN1k8QFNSbULLtVLt00zVpD_57U9YP0FN48z4zk7wjxD7CMQKqk0dQSEaDRg0ARNmamKBCSBFBrYvJaKejvyW2Q5gDZNpAvim2JBBQrnEiXm66sGx62yYXTSjfrH_l5ILLJjSdC8m0cyV717jX5L6t2CcPtm_Y9eEseXZRh966anT7N17dtB-jfPBdySHsio3atoH3vs4d8Xx1-TS9Se_ur2-n53dpSaj6VEpCmgFVpjZVJmda5RlVliqp8tIinioVta6BkMkS1VaSiRiTzHQmM7kjjlZ9l757Hzj0xSJ-htvWOu6GUGQoMXLa5BE9_IPOu8G7-LpIaSmNMYiRwhVV-i4Ez3Wx9M3C-o8CoRijL_5FH2sOvjoPswVXPxXfWUeAfkbPuewXQ-Df6QoNqrx4HPc3ri_K2Fjl8hNSzYy1</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Koskas, Pierre</creator><creator>Pons-Peyneau, 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Discharge Decisions Concerning Older Patients: Understanding the Underlying Process</title><author>Koskas, Pierre ; Pons-Peyneau, Cécile ; Romdhani, Mouna ; Houenou-Quenum, Nadège ; Galleron, Sandrine ; Drunat, Olivier</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-33414b04d9f9d23b87624da4d376ca1157724d8f041e4a44fa3493b8e43282323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Activities of daily living</topic><topic>Age</topic><topic>Caregivers</topic><topic>Clinical decision making</topic><topic>Dementia</topic><topic>Discharge</topic><topic>Discharge planning</topic><topic>Education</topic><topic>Experts</topic><topic>Frailty</topic><topic>Geriatrics</topic><topic>Home health care</topic><topic>Hospitalization</topic><topic>Institutionalization</topic><topic>Kappa coefficient</topic><topic>Medical decision making</topic><topic>Needs 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Aging</addtitle><date>2019-03-01</date><risdate>2019</risdate><volume>38</volume><issue>1</issue><spage>90</spage><epage>99</epage><pages>90-99</pages><issn>0714-9808</issn><eissn>1710-1107</eissn><abstract>ABSTRACTWe aimed to understand clinical decision-making processes that influence the orientation of older patients after hospital discharge. We compared discharge decisions (i.e., discharge home, or nursing home stay) of the hospital team with those of an expert panel. Both panel and hospital team made their decisions independently. The blind study included 102 patients (mean age: 83.13 ± 6.74). There is a statistically significant difference between expert and hospital team decisions (p < .001; kappa coefficient: 0.468). Panel decisions were more closely associated with isolation (p = .018), reliable caregivers (p = .004), social problems (p = .001), and behavioural symptoms perceived as aggressive (p = .001). Both decision processes considered refusal of care (p = 0,025 and 0.016 respectively) and social problems (p = .001 and < 0.001 respectively). Discharge planning models differ depending on the country, team and patient's condition. Our study suggests more precise evaluation of patients' needs.</abstract><cop>Canada</cop><pub>Cambridge University Press</pub><pmid>30404681</pmid><doi>10.1017/S0714980818000442</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-8379-2087</orcidid><oa>free_for_read</oa></addata></record> |
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| source | Sociological Abstracts; Cambridge University Press Journals Complete |
| subjects | Activities of daily living Age Caregivers Clinical decision making Dementia Discharge Discharge planning Education Experts Frailty Geriatrics Home health care Hospitalization Institutionalization Kappa coefficient Medical decision making Needs assessment Nursing homes Older people Patient compliance Patients Refusal Regression analysis Social isolation Social problems Sociodemographics Symptoms Teams Treatment refusal Variables |
| title | Hospital Discharge Decisions Concerning Older Patients: Understanding the Underlying Process |
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