Shared Decision Making in Discharge Planning and Long-Term Care Linkage: A Retrospective Study.

Area of Science:

• Healthcare Management
• Patient Care Coordination
• Health Services Research

Background:

• High-risk hospitalized patients often face challenges in transitioning to long-term care (LTC).
• Effective discharge planning is crucial for successful post-hospitalization outcomes and preventing readmissions.
• Shared decision making (SDM) aims to involve patients and caregivers in care choices.

Purpose of the Study:

• To assess the impact of SDM on LTC service utilization and early readmissions in high-risk hospitalized patients.
• To evaluate patient and caregiver satisfaction with discharge planning facilitated by SDM.
• To identify factors influencing readmission rates among patients receiving SDM.

Main Methods:

• Retrospective observational study involving 436 high-risk patients (ADL score ≤65) at a medical center in Taiwan.
• Utilized a standardized SDM decision aid during discharge planning for collaborative discussions.
• Compared outcomes between patients who received SDM (n=72) and those who did not (n=364), analyzing electronic medical records and national databases.

Main Results:

• The SDM group demonstrated significantly higher LTC integration (95.4% vs 82.7%, P < .001) and greater satisfaction with discharge planning.
• No significant differences in 14-day readmissions were observed between the SDM and non-SDM groups after adjustment.
• Within the SDM group, nonadherence to the care plan was linked to 14-day readmissions, while adherence resulted in zero readmissions.

Conclusions:

• SDM is associated with improved linkage to LTC services and enhanced discharge planning satisfaction.
• While SDM did not significantly alter 14-day readmission rates overall, adherence within the SDM framework was critical for preventing early readmissions.
• SDM positively impacts patient-centered care and satisfaction, suggesting its value for optimizing transitions in care for high-risk populations.