Résumé
Background: Early identification of patients requiring transfer to post-acute care (PAC) facilities shortens hospital
stays. With a focus on interprofessional assessment of biopsychosocial risk, this study’s aim was to assess medical
and neurological patients’ post-acute care discharge (PACD) scores on days 1 and 3 after hospital admission
regarding diagnostic accuracy and effectiveness as an early screening tool. The transfer to PAC facilities served as
the outcome (“gold standard”).
Methods: In this prospective cohort study, registered at ClinicalTrial.gov (NCT01768494) on January 2013, 1432
medical and 464 neurological patients (total n = 1896) were included consecutively between February and October
2013. PACD scores and other relevant data were extracted from electronic records of patient admissions, hospital
stays, and interviews at day 30 post-hospital admission. To gauge the scores’ accuracy, we plotted receiver
operating characteristic (ROC) curves, calculated area under the curve (AUC), and determined sensitivity and
specificity at various cut-off levels.
Results: Medical patients’ day 1 and day 3 PACD scores accurately predicted discharge to PAC facilities, with
respective discriminating powers (AUC) of 0.77 and 0.82. With a PACD cut-off of ≥8 points, day 1 and 3 sensitivities
were respectively 72.6% and 83.6%, with respective specificities of 66.5% and 70.0%. Neurological patients’ scores
showed lower accuracy both days: using the same cut-off, respective day 1 and day 3 AUCs were 0.68 and 0.78,
sensitivities 41.4% and 68.7% and specificities 81.4% and 83.4%.
Conclusion: PACD scores at days 1 and 3 accurately predicted transfer to PAC facilities, especially in medical
patients on day 3. To confirm and refine these results, PACD scores’ value to guide discharge planning
interventions and subsequent impact on hospital stay warrants further investigation.
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