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document
Are PRO discharge screens associated with postdischarge adverse outcomes ? OBJECTIVE We evaluate whether patient outcomes may be affected by possible errors in care at discharge as assessed by Peer Review Organizations ( PROs ) . DATA SOURCES/STUDY SETTING The three data sources for the study were ( 1 ) the generic screen results of a 3 percent random sample of Medicare beneficiaries age 65 years or older who were admitted to California hospitals between 1 July 1987 and 30 June 1988 ( n = 20,136 patients ) ; ( 2 ) the 1987 and 1988 California Medicare Provided Analysis and Review ( MEDPAR ) data files ; and ( 3 ) the American Hospital Association ( AHA ) 1988 Annual Survey of Hospitals . STUDY DESIGN Multivariate logistic regression analysis was used to evaluate the association between the results of generic discharge administered by the PROs and two patient outcomes : mortality and readmission within 30 days . The analysis was adjusted for other patient characteristics recorded on the uniform discharge abstract . PRINCIPAL FINDINGS Four discharge screens indicated an increased risk of an adverse outcome-absence of documentation of discharge planning , elevated temperature , abnormal pulse , and unaddressed abnormal test results at discharge . The other three discharge screens examined-abnormal blood pressure , IV fluids or drugs , and wound drainage before discharge-were unrelated to postdischarge adverse outcomes . CONCLUSIONS Generic discharge screens based on inadequate discharge planning , abnormal pulse , increased temperature , or unaddressed abnormal tests may be important indicators of substandard care . Other discharge screens apparently do not detect errors in care associated with major consequences for patients .
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Intervention_Other
PRO discharge screens
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Intervention_Other
generic screen results
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Intervention_Other
Analysis and Review ( MEDPAR ) data files ;
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Intervention_Other
Multivariate logistic regression analysis
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Intervention_Educational
Generic discharge screens
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Outcome_Other
risk of an adverse outcome-absence of documentation of discharge planning
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Outcome_Physical
elevated temperature
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Outcome_Physical
abnormal pulse
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Outcome_Physical
unaddressed abnormal test results
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Outcome_Physical
examined-abnormal blood pressure
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Outcome_Physical
IV fluids or drugs
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Outcome_Physical
wound drainage
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Outcome_Physical
abnormal pulse
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Outcome_Physical
increased temperature
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Outcome_Physical
unaddressed abnormal tests
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Participant_Condition
The three data sources for the study were ( 1 ) the generic screen results of a 3 percent random sample of Medicare beneficiaries age 65 years or older who were admitted to California hospitals between 1 July 1987 and 30 June 1988 ( n = 20,136 patients ) ; ( 2 ) the 1987 and 1988 California Medicare Provided Analysis and Review ( MEDPAR ) data files ; and ( 3 ) the American Hospital Association ( AHA ) 1988 Annual Survey of Hospitals .