Comparison of two surveys of hospitalization: the National Hospital Discharge Survey and the NHANES I Epidemiologic Followup Study

Objectives This report compares hospitalization data from the NHANES I Epidemiologic Followup Study (NHEFS) with data from the National Hospital Discharge Survey (NHDS), the benchmark for hospitalization in the United States, for men and women 35 years and older for the period 1971\ue2\u20ac\u201c87. The comparison is intended to help analysts evaluate the validity and generality of analyses based on the NHEFS. Methods Hospital stays per 1,000 population and average lengths of stay are compared year by year for each age-sex group and for the entire period. Regression analyses test for differences between the two surveys by age and sex, and for differences in trends over time and the effect of the Medicare program\ue2\u20ac\u2122s prospective hospital payment system. Results Hospital stays per 1,000 population were lower in NHEFS than in NHDS in all age-sex groups at the beginning of the period, but the differences had almost disappeared by 1987. Lengths of stay, although somewhat longer in NHEFS, matched NHDS more closely. Differentials by age and sex were similar in the two surveys for both hospital stays per 1,000 population and length of hospital stay. With its extensive information on baseline risk factors, the NHEFS offers a unique opportunity to study determinants of hospitalization in a representative sample of U.S. adults. The evaluation presented here suggests two points for researchers who want to use the NHEFS. First, including age as a control should largely correct for differences in age distribution between NHEFS and NHDS. Second, a time trend should also be included to capture the effects of several factors that caused the count of stays to be low in the early years of NHEFS followup.[L.B. Russell, E. Milan, and R. Jagannathan]."September 1997."Also available via the World Wide Web.Includes bibliographical references (p. 11)

Discharge Teaching to Improve Discharge Readiness for Patients Post Hip Surgery

The condition of returning home unpreparedness post hip surgery has an impact on the patient's ability after returning home. This unpreparedness is caused by the inability of patients to manage their own needs and care needs after returning home in carrying out daily tasks, caring for themselves, and the ability to do health care. So that a nursing strategy is needed in preparing the patient's discharge planning in the form of discharge teaching. Four data bases namely Cochrane, EBSCO, Google Scholar, and Scopus were used to explain the effect of discharge teaching to improve patient readiness post hip surgery. Educational needs expected by patients post hip surgery are related to complications, operating procedures, rehabilitation programs, prosthesis, and pain management. Patients hope to get knowledge related to all dimensions, but in reality they only get from the functional dimension. Patients get more knowledge only during treatment than when they are going home. Discharge teaching must also pay attention to the content of information and delivery methods and must be given in all stages of treatment and repetition of important items. So nurses are required to have competence and knowledge in carrying out discharge teaching with the aim of increasing patient readiness.   Keywords: discharge teaching, discharge readiness, post hip surger

Discharge Teaching, Readiness for Discharge, and Post-discharge Outcomes in Parents of Hospitalized Children

Purpose This study explored the sequential relationships of parent perceptions of the quality of their discharge teaching and nurse and parent perceptions of discharge readiness to post-discharge outcomes (parental post-discharge coping difficulty, readmission and emergency department visits). Design/methods In this secondary analysis of data from a longitudinal pilot study of family self-management discharge preparation, the correlational design used regression modeling with data from a convenience sample of 194 parents from two clinical units at a Midwest pediatric hospital. Data were collected on the day of discharge (Quality of Discharge Teaching Scale; Readiness for Hospital Discharge Scale), at 3 weeks post-discharge (Post-Discharge Coping Difficulty Scale), and from electronic records (readmission, ED visits). Results Parent-reported quality of discharge teaching delivery (the way nurses teach), but not the amount of content, was positively associated with parent perception (B = 0.54) and nurse assessment (B = 0.16) of discharge readiness. Parent-reported discharge readiness was negatively associated with post-discharge coping difficulty (B = − 0.52). Nurse assessment of discharge readiness was negatively associated with readmission; a one point increase in readiness (on a 10 point scale) decreased the likelihood of readmission by 52%. Conclusion There is a sequential effect of quality of discharge teaching delivery on parent discharge readiness, which is associated with parent coping difficulty and child readmission. Practice Implications Efforts to improve discharge outcomes should include strategies to build nurse teaching skills for high-quality delivery of discharge teaching. In addition, routine nurse assessment of discharge readiness can be used to identify children at risk for readmission and trigger anticipatory interventions

Predictors and Outcomes of Postpartum Mothers\u27 Perceptions of Readiness for Discharge after Birth

Objective: To identify predictors and outcomes of postpartum mothers\u27 perceptions of their readiness for hospital discharge. Design: A correlational design with path analyses was used to explore predictive relationships among transition theory-related variables. Setting: Midwestern tertiary perinatal center. Participants: One hundred and forty-one mixed-parity postpartum mothers who had experienced vaginal birth or Cesarean delivery of normal healthy infants. Methods: Before hospital discharge, patients completed questionnaires about sociodemographic characteristics, hospitalization factors, quality of discharge teaching, and readiness for discharge. Three weeks postdischarge, mothers were contacted by telephone to collect coping difficulty and health care utilization data. Main Outcome Measures: Readiness for Hospital Discharge Scale, Post-Discharge Coping Difficulty Scale, Utilization of postdischarge services. Results: Quality of discharge teaching, specifically the relative difference in the amount of informational content needed and received and the skills of nurses in delivering discharge teaching, explained 38% of the variance in postpartum mothers\u27 perceptions of discharge readiness. Readiness for discharge scores explained 22% of the variance in postdischarge coping difficulty scores. Nurses\u27 skills in delivery of discharge teaching, coping difficulty, patient characteristics, and birth hospitalization factors were predictive of utilization of family support and postdischarge health care services. Conclusion: A trajectory of influence was evident in the sequential relationships of quality of discharge teaching, readiness for discharge, postdischarge coping, and utilization of family support and health care services. Transitions theory provided a useful framework for conceptualizing and investigating the transition home after childbirth

River Discharge

In 2014, combined discharge from the eight largest Arctic rivers (2,487 km3) was 10% greater than average discharge for the period 1980-1989. Values for 2013 (2,282 km3) and 2012 (2,240 km3) were 1% greater than and 1% less than the 1980-1989 average, respectively. For the first seven months of 2015, the combined discharge for the six largest Eurasian Arctic rivers shows that peak discharge was 10% greater and five days earlier than the 1980-1989 average for those months

Patients’ Perceptions of Relative Importance of Discharge Elements (PRIDE) Study

Background: Almost 20% of patients experience potentially preventable adverse events within 30 days of hospital discharge (Forster, et al, 2003). The Agency for Healthcare Research and Quality recommends structured and patient-centered discharge communication to prevent adverse events post-discharge (2018). The Joint Commission mandates information that must be included in all discharge communication including reason for hospitalization, significant findings, procedures and treatment provided, patient\u27s discharge condition, patient and family instructions, and attending physician signature (Horwitz, et al, 2013). There is limited data suggesting how healthcare providers believe discharge communication should be prioritized. Blaine, et al, 2018 cites Discharge Education/Teach-back and Involve Care Team as the aspects perceived by providers as having the highest importance. Sorita, et al, 2017 cites medical history, physical findings, cognitive and functional status at discharge, and rationale for medication changes to be “very important” Patient satisfaction with discharge information strongly correlates to overall satisfaction with hospital care (Waniga, et al, 2016). Surprisingly, there is no data on patient’s perceptions about discharge instruction elements and on the relative importance of discharge information. One study demonstrated that 44% of patients felt that improvements were needed to the areas of formatting/layout, clarity, correcting discrepancies/omitted information (Corser, et al, 2017). Determining how discharge information should prioritized may help to make discharge communication more patient-centered, and prevent readmissions and adverse events

Perceived Readiness for Hospital Discharge in Adult Medical-Surgical Patients

Purpose: The purpose of the study was to identify predictors and outcomes of adult medical-surgical patients\u27 perceptions of their readiness for hospital discharge. Design: A correlational, prospective, longitudinal design with path analyses was used to explore relationships among transition theory-related variables. Setting: Midwestern tertiary medical center. Sample: 147 adult medical-surgical patients. Methods: Predictor variables included patient characteristics, hospitalization factors, and nursing practices that were measured prior to hospital discharge using a study enrollment form, the Quality of Discharge Teaching Scale, and the Care Coordination Scale. Discharge readiness was measured using the Readiness for Hospital Discharge Scale administered within 4 hours prior to discharge. Outcomes were measured 3 weeks postdischarge with the Post-Discharge Coping Difficulty Scale and self-reported utilization of health services. Findings: Living alone, discharge teaching (amount of content received and nurses\u27 skill in teaching delivery), and care coordination explained 51% of readiness for discharge score variance. Patient age and discharge readiness explained 16% of variance in postdischarge coping difficulty. Greater readiness for discharge was predictive of fewer readmissions. Conclusions: Quality of the delivery of discharge teaching was the strongest predictor of discharge readiness. Study results provided support for Meleis\u27 transitions theory as a useful model for conceptualizing and investigating the discharge transition. Implications for Practice: The study results have implications for the CNS role in patient and staff education, system building for the postdischarge transition, and measurement of clinical care outcomes