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Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals

Holland, Diane E. PhD, RN; Brandt, Cheryl PhD, RN; Targonski, Paul V. MD, PhD; Bowles, Kathryn H. PhD, RN

doi: 10.1097/NCM.0000000000000233

Purpose of Study: The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting.

Primary Practice Setting: Rural regional community hospital.

Methodology and Sample: We designed a comparative, descriptive survey study and enrolled a convenience sample of 222 patients (identified at admission) who provided informed consent. Sample characteristics and ESDP scores were collected during enrollment. The Problems After Discharge Questionnaire, EuroQoL-5Dimensions quality-of-life measure, length of stay, and use of post-acute care services were recorded after discharge. We compared outcomes between patients with low and high ESDP scores.

Results: More than half of the sample (51.8%) had a high ESDP score. Patients with high ESDP scores reported more problems after discharge (p = .02), reported lower quality of life (p < .001), had longer length of stays (p = .04), and used post-acute care services (p = .006) more than patients with low ESDP scores. The difference in the average percentage of unmet needs was not statistically significant (p = .12), but patients with high ESDP scores reported more unmet needs than patients with low ESDP scores.

Implications for Case Management Practice: The value of systematically proactive approaches to discharge planning is increasingly recognized, but establishing the performance capacity of support tools is critical for optimizing benefit. These study findings support use of the ESDP in regional community hospitals, making it a useful, open-source decision support tool for various health care delivery systems.

Diane E. Holland, PhD, RN, is Nurse Scientist in the Department of Nursing and an Associate Professor, College of Medicine, Mayo Clinic, Rochester, MN. She is a fellow in the Gerontological Society of America. Her research interests include transitioning patients from the hospital to home safely and successfully.

Cheryl Brandt, PhD, RN, is Professor, Department of Nursing, College of Natural Sciences, California State University, San Bernadino. At the time of the study, Dr Brandt was Professor, University of Wisconsin, Eau Claire, and Research Specialist, Nursing Department, Mayo Clinic Health System–Eau Claire, WI.

Paul V. Targonski, MD, PhD, is the Director for Clinical Research Initiatives, Department of Public Health Sciences, and Director for Research, Division of General Medicine, University of Virginia. He implements and evaluates clinical and community initiatives to advance safe, high-quality care impacting population health outcomes and successful aging.

Kathryn H. Bowles, PhD, RN, is the van Ameringen Professor in Nursing Excellence at the University of Pennsylvania School of Nursing and Vice President and Director of the Center for Home Care Policy and Research at the Visiting Nurse Service of New York.

Address correspondence to Diane E. Holland, PhD, RN, Department of Nursing, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (

The authors report no conflicts of interest.

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