Implementation of discharge planning in the care of hospitalized older adults. Focus on involvement of home care providers at hospitals

OBJECTIVES: The present study was conducted to assess current implementation of discharge planning in the care of hospitalized older adults, and to examine the association between implementation and involvement of home care providers at hospitals. METHODS: The subjects were 434 hospitals with 100 beds or more for general patients, nationwide. We conducted a questionnaire survey by mail of hospital staff responsible for the discharge planning, and assessed to what extent home care providers were associated with the implementation of discharge planning in the hospitals. The subjects were divided into two groups: an association group (138 hospitals) in which home care providers were associated with implementation in the hospitals, and a not-association group (296 hospitals). We compared the proportions of implementation of discharge planning between the two groups, and calculated odds-ratios. In the analysis, we controlled for affiliated institution and home care services. RESULTS: The association group showed significantly higher proportions of implementation for 13 items in a total 24 items for discharge planning than the not-association group (range of odds-ratio: 2.430-5.497). The three highest odds ratios were observed for "Arrangement and guidance for home care by outreach prior to discharge" [OR= 5.497, 95% confidence interval (CI): 2.604-11.602], "Adjusting relationship between patient and family" (OR=4.871, 95%CI: 1.323-17.930) and "Refining medical and nursing care so as to be sustainable at home" (OR = 4.740, 95%CI: 1.825-12.311). CONCLUSIONS: The present study showed that hospitals with involvement of home care providers had higher proportions of implementation of discharge planning for hospitalized older adults concerning "Arrangement and guidance for home care by outreach prior to discharge", "Adjusting relationship between patient and family", "Refining medical and nursing care so as to be sustainable at home" and so on. Further study should examine the effect of discharge planning on length of stay, rate of readmission, patient and family member's satisfaction controlling for patient characteristics and hospital's role in the community.