老年病人的出院计划（英文PPT）Discharge Planning for the Geriatric Patient Pearls and Pitfalls.ppt

Discharge Planning for the Geriatric Patient:Pearls and Pitfalls Adrienne Green, M.D. Bill Lyons, M.D. University of California San Francisco Objectives Understand predictors of poor discharge outcomes in the elderly patient Appreciate alternatives for post-acute care Home Care Skilled nursing or sub-acute facilities Acute rehabilitation facility Hospice Provide strategies for improving discharge planning, communication and outcomes Background 10 million discharges/yr Medicare pts Quicker and sicker discharges of older and frailer patients JCAHO guidelines for multi-disciplinary d/c planning as component of high-quality care HCFA regulates discharge planning Poor hospital reimbursement if pt no longer acute Predictors of Poor Post-Discharge Outcomes Age 80 Multiple, active medical problems Multiple hospitalizations last 6 months Hospitalized within last 30 days History of depression Moderate-to-severe functional impairment Inadequate support system “Fair” or “Poor” self-rating of health History of non-compliance Case #1: Home Care Ms. Bea Atome is an 82 y/o woman with colon CA s/p resection with new colostomy. Hospitalization complicated by delirium and line infection requiring 2 weeks IV antibiotics. Pt. lives alone, scant family in Wisconsin, never finished grade school, neighbors help with grocery shopping. Case #1: Home Care Pt. is AAO X 3. Can do basic ADL’s but ambulation limited by osteoarthritis and deconditioning. You decide that Ms. Bea Atome is able to return home with home health. What are predictors of home health use? Lower educational level Less accessible social support Impairment in at least one IADL Prior home health care use Solomon et al. J. Am. Geriatric Soc. 1993 What are this patient’s post-discharge needs? IV antibiotics Ostomy care and education PT/OT Assistance with bathing, cooking, shopping etc. Is this patient “homebound?” Medicare/Medical only reimburse if pt “homebound” with skilled needs “Homebou