Who Knows Best? Nurse and Patient Perceptions of Discharge Readiness as Predictors of

advertisement
Who Knows Best?
Nurse and Patient
Perceptions of Discharge
Readiness as Predictors of
Post-Discharge Utilization
Marianne Weiss, RN, DNSc
Olga Yakusheva, PhD
Kathleen Bobay, RN, PhD
Marquette University
Funding
Robert Wood Johnson Foundation
Interdisciplinary Nursing Quality Research
Initiative
Discharge and Readmission
 National agenda


Improving the discharge transition
Reducing readmission
 Our study of the discharge transition




Nurse practice environment
Quality of discharge teaching
Readiness for hospital discharge
Readmission and ED visits
Patient and Nurse Perceptions of
Discharge Readiness
 1.
evaluate the association and level of agreement between nurse
and patient perceptions of discharge readiness;
 2.
examine nurse and patient perceptions of discharge readiness as
predictors of readmission and/or ED visits within the first 30 days
post-discharge;
 3.
determine the contributions of patient characteristics to patient and
nurse discharge readiness assessment and post-discharge
utilization;
 4.
describe the sensitivity, specificity, positive predictive value, and
negative predictive value of various levels of nurse and patient
ratings of discharge readiness.
Sample: n=162
 Adult medical surgical patients and their
discharging nurses
 From 13 medical surgical units
 From 4 hospitals
 Discharged home (home hospice excluded)
 Speak English or Spanish
Sub-sample of the parent study sample of
1898 randomly selected patients
Sample Characteristics
Patients
Nurses
 Mean age:
 Mean experience =




58.7 years (sd=17.1)
Male: 48%
SES: 38.8 (sd=13.5)
Living alone: 23%
Race: 79% White,
12% Black
7.3 years (sd=9.4).
 Education: 64% BSN
 Expertise: 28% proficient
or expert
Measures
Readiness for Hospital Discharge Scale (RHDS)






Patient self report
21 item summated rating scale using a 0 to 10 response
format
Subscales
 Personal status
 Knowledge
 Perceived Coping Ability
 Expected Support
Reliability: .87 / .69-.88
Validity: CFA supports 4 factor structure
Prior study documented relationship between RHDS and
readmission
Measures
RN Readiness for Hospital Discharge Scale



Nurse assessment
Same items as RHDS modified for nurses
Reliability: .90 / .75 -.92
 Post-discharge utilization

Occurrence of readmission or an ED visit in
the first 30 days post-discharge to any of 4
hospitals in the study health system
Data Collection
 RHDS and RNRHDS

Within 4 hours prior to discharge
 Post-discharge Utilization


Electronic extraction from HIS
Medical record review
RHDS Scale Statistics
Association and Agreement
 Correlations between RHDS & RNRHDS


0.15 (p=.06) for total scale
0.12 to 0.32 for subscales
 Agreement with single readiness item: 92%
 Agreement RHDS & RNRHDS <1 sd:
78%
Logistic Regression: RHDS and RNRHDS
as predictors of readmission/ED visits
Regression Analyses:
Patient characteristics as predictors of
Readmission/ED, RHDS, RNRHDS
Final Model: RHDS and RNRHDS
as predictors of Readmission/ED
with patient controls
RHDS:
Sensitivity, Specificity, PPV, NPV
RNRHDS:
Sensitivity, Specificity, PPV, NPV
RNRHDS Subscales
PPV
Summary
 Nurses rate patient readiness for discharge higher than
patients.
 Readiness for discharge assessed by nurses is more
predictive of readmission/ED than patient self-assessment.
 Patient characteristics improve prediction of readmission/ED
visits.
 Positive predictive values suggest RNRHDS could be useful
as a screening tool for patients at risk for adverse postdischarge occurrences.
Next steps
 Reduce number of items on RHDS
 Test use of RHDS as a screening tool in
conjunction with anticipatory and ‘rescue’
interventions.
Contact Information
 [email protected][email protected][email protected]
Download