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Comprehensive Discharge Planning for the Hospitalized Elderly: A Randomized Clinical Trial

Mary Naylor, PhD; Dorothy Brooten, PhD; Robert Jones, PhD; Risa Lavizzo-Mourey, MD, MBA; Mathy Mezey, EdD; and Mark Pauly, PhD
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From the University of Pennsylvania, Philadelphia, Pennsylvania; the Agency for Health Care Policy and Research, Rockville, Maryland; New York University, New York, New York. Requests for Reprints: Mary D. Naylor, PhD, University of Pennsylvania School of Nursing, 420 Guardian Drive, Philadelphia, PA 19104. Acknowledgments: The authors thank Project Manager Roberta Campbell, MSN, RN, and all research team members; Statistical Consultant Barbara Jacobsen, MS; and the Leonard Davis Institute of Health Economics at the University of Pennsylvania. Grant Support: By the National Institute of Nursing Research (NR02095-05).

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(12):999-1006. doi:10.7326/0003-4819-120-12-199406150-00005
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Objective: To study the effects of a comprehensive discharge planning protocol, designed specifically for the elderly and implemented by nurse specialists, on patient and caregiver outcomes and cost of care.

Design: Randomized clinical trial.

Setting: Hospital of the University of Pennsylvania.

Patients: 276 patients and 125 caregivers. Patients were 70 years and older and were placed in selected medical and surgical cardiac diagnostic-related groups.

Measurements: Group differences in patient outcomes (length of initial hospital stay, length of time between initial hospital discharge and readmission, and rehospitalization rates) and charges for care (charges for initial hospitalization, rehospitalizations, health services after discharge, and nurse specialist services) were measured 2, 6, and 12 weeks after discharge.

Results: From the initial hospital discharge to 6 weeks after discharge, patients in the medical intervention group had fewer readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for health care services after discharge. No differences in these outcomes were found between the surgical intervention and control groups during this period.

Conclusions: Study findings support the need for comprehensive discharge planning designed for the elderly and implemented by nurse specialists to improve their outcomes after hospital discharge and to achieve cost savings. The findings also suggest that this intervention had its greatest effect in delaying or preventing rehospitalization of patients in the medical intervention group during the first 6 weeks after discharge.





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