Academic journal article Health and Social Work

Discharge Planning in Acute Care Hospitals in Israel: Services Planned and Levels of Implementation and Adequacy

Academic journal article Health and Social Work

Discharge Planning in Acute Care Hospitals in Israel: Services Planned and Levels of Implementation and Adequacy

Article excerpt

Discharge from a hospital does not necessarily indicate a return to health, but, rather, a move from acute care to alternate, lower intensity forms of care. In many countries, efforts to reduce health costs have led to shortened hospital stays and a deliberate shift toward community care. Although there are a variety of services to meet the demand for continuing care, the transition from hospital to community is often problematic. Patients and families report extended waiting times, limited accessibility, inadequate services, unmet needs, poor coordination, insufficient information, and lack of resources (Proctor, Morrow-Howell, Li, & Dore, 2000; Waters, Allsopp, Davidson, & Dennis, 2001).

Negotiating the transition between inpatient and community care often requires the assistance of skilled discharge planners, usually social workers or nurses (Holliman, Dziegielewski, & Teare, 2003). In Israel, social workers do most of the discharge planning in acute care hospitals, screening for high-risk patients and intervening with those referred by staff members, particularly complex cases. Discharge planning includes early identification and assessment of patients likely to require services; coordinating the multidisciplinary health care team's discharge-related activities; identifying and coordinating resources necessary for post-hospital care; providing information to patients and families to assist them in selecting and applying for services; and follow-up of discharged patients (Auslander & Soskolne, 1993). In practice, discharge planners' time is spent mainly on assessment and coordination, whereas follow-up is rarely done (Holliman, Dziegielewski, & Datta, 2001).

Early studies of discharge planning emphasized the efficiency and timing of care, particularly early identification and intervention (Berkman & Rehr, 1972; Boone, Coulton, & Keller, 1981). More recent studies examined various outcomes of discharge planning, including the implementation of those plans and the adequacy of services received (Bowles, Naylor, & Foust, 2002; Morrow-Howell, Proctor, & Rozario, 2001; Proctor et al., 2000). The study reported here aimed to assess discharge planning in Israel, focusing on the types of services planned, adequacy of services, and factors related to implementation.

BACKGROUND

Implementation of Care

Over the years, reports consistently indicate that 30 percent to 40 percent of patients experience some discrepancy between their discharge plan and its implementation (Morrow-Howell, Chadiha, Proctor, Hourd-Bryant, & Dore, 1996; Simon, Showers, Blumenfield, Holden, & Wu, 1995; Waters et al., 2001).

A variety of factors may affect the implementation of discharge plans. Results vary with type of service--Those directed at meeting short-term acute medical needs are more likely to be implemented than are those aimed at meeting personal needs, household chores, or complex medical needs (Proctor et al., 2000; Simon et al., 1995; Waters et al., 2001). Another important factor is eligibility determination procedures; services requiring post-discharge in-home evaluation of patient needs are less likely to be implemented (Simon et al., 1995). Among patient-related factors, functional and cognitive impairment, extended length of stay, and hospitalization in internal medicine departments are related to implementation problems (Ayalon, 2001; Cummings, 1999; Epstein et al., 1998; Morrow-Howell et al., 1996; Simon et al., 1995). Living arrangement, marital status, and other indicators of support networks, as well as gender, have been found to be related to implementation as well, although the direction of that relationship is not consistent (Ayalon, 2001; Berg & Yuval, 1998; Cummings, 1999; Morrow-Howell et al., 1996; Simon et al., 1995). Minority group membership (Chadiha, Proctor, Morrow-Howell, Darkwa, & Dore, 1995; Morrow-Howell et al. …

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