Managing postacute hospital care: a case for biopsychosocial needs

This study aimed to investigate whether, for an identical diagnosis, patients who were transferred to a postacute care (PAC) facility had a higher biopsychosocial complexity than patients who were discharged home.

This prospective study employed group comparison that included 166 patients who were consecutively admitted to an acute care internal medicine ward for acute congestive heart failure, pneumonia or exacerbation of chronic obstructive pulmonary disease, and malaise or fall. Patients were evaluated within their first 48 h of stay. Biomedical, functional, quality of life, and case complexity data were collected. Factors associated with a transfer to the PAC facility were identified through logistic regression modeling.

Fifty-eight patients (34.9%) were transferred. In the multivariate analyses, case complexity score [per point: odds ratio (OR)=1.29; 95% CI=1.18-1.41] and nursing workload (OR=1.06; 95% CI=1.01-1.12) were associated with the transfer. At a cutoff point of > or =33, the case complexity score predicted transfer to the PAC facility with a sensitivity of 79% and a specificity of 84% (positive predictive value=73.0%; negative predictive value=88.4%) and correctly classified 83% of the cases.

Biomedical characteristics alone did not differentiate patients who were transferred versus those who were discharged home, nor did it predict PAC use. This was also true for specific severity scores of cardiac failure and pneumonia as well as for the comorbidity index. Psychosocial parameters were significantly associated to this process as well as a higher nursing workload.