Data from: Improving the post-acute care discharge score (PACD) by adding patients’ self-care abilities: a prospective cohort study

Background: Reducing delays in hospital discharge is important to improve
transition processes and reduce health care costs. The recently proposed
post-acute care discharge score focusing on the self-care abilities before
hospital admission allows early identification of patients with a need for
post-acute care. New limitations in self-care abilities identified during
hospitalization may also indicate a risk. Our aim was to investigate
whether the addition of the post-acute care discharge score and a
validated self-care instrument would improve the prognostic accuracy to
predict post-acute discharge needs in unselected medical inpatients.
Methods: We included consecutive adult medical and neurological
inpatients. Logistic regression models with area under the receiver
operating characteristic curve were calculated to study associations of
post-acute discharge score and self-care index with post-acute discharge
risk. We calculated joint regression models and reclassification
statistics including the net reclassification index and integrated
discrimination improvement to investigate whether merging the self-care
index and the post-acute discharge score leads to better diagnostic
accuracy. Results: Out of 1342 medical and 402 neurological patients, 150
(11.18%) and 94 (23.38%) have reached the primary endpoint of being
discharged to a post-acute care facility. Multivariate analysis showed
that the self-care index is an outcome predictor (OR 0.897, 95%CI
0.864–0.930). By combining the self-care index and the post-acute care
discharge score discrimination for medical (from area under the curve 0.77
to 0.83) and neurological patients (from area under the curve 0.68 to
0.78) could be significantly improved. Reclassification statistics also
showed significant improvements with regard to net reclassification index
(14.2%, p<0.05) and integrated discrimination improvement (4.83%,
p<0.05). Conclusions: Incorporating an early assessment of
patients’ actual intrahospital self-care ability to the post-acute care
discharge score led to an improved prognostic accuracy for identifying
adult, medical and neurological patients at risk for discharge to a
post-acute care facility.