Abstract
Objectives
To describe and validate the Post-acute Delayed Discharge Risk Scale (PADDRS), which
classifies patients by risk of delayed discharge on admission to post-acute care settings
using information collected with the interRAI Minimum Data Set (MDS) 2.0 assessment.
Design
Retrospective cohort study of individuals admitted to Ontario Complex Continuing Care
(CCC) hospitals. Person-level linkage between interRAI MDS 2.0 assessments and Cancer
Care Ontario Wait Time Information System records was performed.
Setting and Participants
Sample of 30,657 patients who received care in an Ontario CCC hospital and were assessed
with the interRAI MDS 2.0 assessment between January 1, 2010, and March 31, 2013.
Measures
Alternate Level of Care (ALC) designation of 30 or more days was used as the marker
of delayed discharge. Scale validation was performed through computation of class-level
effect sizes and receiver operating characteristic curves for each of Ontario's geographic
health regions. Additionally, Clinical Assessment Protocol (CAP) decision-support
tool trigger rates by PADDRS risk level were computed for problem areas that are clinically
relevant with the delayed discharge outcome.
Results
Overall, 9.4% of the sample experienced the delayed discharge outcome. The PADDRS
algorithm achieved an overall area under the curve (AUC) statistic of 0.74, which
indicates good discriminatory ability for predicting delayed discharge. PADDRS is
generalizable across geographic regions, with AUC statistics ranging between 0.61
and 0.81 across each of Ontario's 14 Local Health Integration Networks. PADDRS demonstrated
strong concurrent validity, as the percentage of patients triggering CAPs increased
with the risk of delayed discharge.
Conclusions and Implications
PADDRS combines numerous important clinical factors associated with delayed discharge
from a post-acute hospital into a cohesive decision-support tool for use by discharge
planners. In addition to early identification of patients who are most likely to experience
delayed discharge, PADDRS has applications in risk-adjusted quality measurement of
discharge planning efficiency.
Keywords
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Article info
Publication history
Published online: February 20, 2020
Footnotes
L.A.T. is supported by a Canadian Institutes of Health Research (CIHR) Health System Impact Fellowship.
The authors declare no conflicts of interest.
Competing Interests: The authors declare that they have no competing interests.
Identification
Copyright
Crown Copyright © 2020 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
