An early warning tool for predicting at admission the discharge disposition of a hospitalized patient

To develop an early warning discharge disposition prediction tool based on clinical and health services factors for hospitalized patients. Recent study results suggest that early prediction of discharge disposition (ie, whether patients can return home or require placement in a facility) can improve care coordination, expedite care planning, and reduce length of stay.

Retrospective analysis of inpatient data; development of multiple logistic regression model and an easy-to-use score.

We used retrospective data from all patients who were admitted in 2013 to the general medical service at the Veterans Affairs Boston Healthcare System and discharged alive. A derivation-validation approach was used to build a multiple logistic regression model, which was transformed into a score for potential implementation.

Of the 4760 patients discharged in 2013, 485 (10.2%) were discharged to a facility other than home. Correlates of discharge to a facility included a primary admission diagnosis of neoplasm (odds ratio [OR], 2.71; 95% CI, 1.73-4.25), diseases of the nervous system (OR, 2.53; 95% CI, 1.26-5.08), and musculoskeletal diseases (OR, 2.55; 95% CI, 1.52-4.27), as well as discharge to a facility during previous hospitalization. Patients with a prior primary diagnosis of circulatory disorder and those with comorbidity of hypertension, either complicated or uncomplicated, were less likely to be discharged to a facility. A value of 5 or greater on the 20-point scale indicated discharge to a facility with 83% sensitivity and 48% specificity.

A validated, easy-to-use score can assist providers in identifying upon admission those patients who may not be able to go directly home after hospitalization, thus facilitating early discharge planning and coordination, potentially reducing length of hospital stay and improving patient experience.