ArticleJournal of the American Medical Directors Association2019
Using a Decision Support Algorithm for Referrals to Post-Acute Care.
Article in Journal of the American Medical Directors Association, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 43 citations in OpenAlex.
- Systematic review of prediction models for postacute care destination decision-making.Journal of the American Medical Informatics Association : JAMIA · 2021Pooled it
- Standard-of-care vs. machine learning-recommended discharge destinations for geriatric surgical inpatients: algorithm development and internal validation.European geriatric medicine · 2026Article
- Timing and Intensity of Rehabilitation Services During Acute Stroke Hospitalization: Impacts on Functional Recovery and Community Discharge.The American journal of occupational therapy : official publication of the American Occupational Therapy Association · 2026Observational
- Identifying Key Predictors of Appropriate Discharge Destinations for Older Inpatients in Acute Care: Scoping Review.Interactive journal of medical research · 2026Review
- Making Community-Based Palliative Care Eligibility Determinations: Palliative Care Team Member Perspectives on Access to Information and Algorithm Use.The American journal of hospice & palliative care · 2025Article
- Patient-level barriers, related facilitators, and proposed strategies for timely home health care and outpatient appointments for sepsis survivors: Perspectives from healthcare system and home health care informants.Patient education and counseling · 2025Article
- Using Machine Learning to Identify Social Determinants of Health that Impact Discharge Disposition for Hospitalized Patients.Journal of the American Medical Directors Association · 2025Article
- Characteristics and Readmission Risks Following Sepsis Discharges to Home.Medical care · 2025Article
- Assessing Family Caregiver Readiness for Hospital Discharge of Patients With Serious or Life-Limiting Illness Using Electronic Health Record (EHR) and Self-Reported Data.Health services research · 2025Article
- Application of a Human Factors and Systems Engineering Approach to Explore Care Transitions of Sepsis Survivors From Hospital to Home Health Care.Human factors · 2024Article
- Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay.Annals of geriatric medicine and research · 2023Article
- Artificial intelligence in clinical decision support systems for oncology.International journal of medical sciences · 2023Review
- Ability of the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT) to Predict Discharge to Institutional Postacute Care.Archives of physical medicine and rehabilitation · 2022Article
- Referral to geriatric rehabilitation: a scoping review of triage factors in acutely hospitalised older patients.Age and ageing · 2022Article
- Barriers to acute care discharge from an urban center before and during the COVID-19 pandemic.The Brown journal of hospital medicine · 2022Article
- Factors Associated with Transfer from an Acute Geriatric Unit to a Post-Acute Care Facility among Community-Dwelling Patients: Results from the DAMAGE Cohort.Clinical interventions in aging · 2022Article
- Identifying Barriers to Post-Acute Care Referral and Characterizing Negative Patient Preferences Among Hospitalized Older Adults Using Natural Language Processing.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2022Article
- Improving the Delivery of Function-Directed Care During Acute Hospitalizations: Methods to Develop and Validate the Functional Assessment in Acute Care Multidimensional Computerized Adaptive Test (FAMCAT).Archives of rehabilitation research and clinical translation · 2021Article
- Timing of Home Health Care Initiation and 30-Day Rehospitalizations among Medicare Beneficiaries with Diabetes by Race and Ethnicity.International journal of environmental research and public health · 2021Article
- Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.International journal of environmental research and public health · 2021Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectivesAlthough hospital clinicians strive to effectively refer patients who require post-acute care (PAC), their discharge planning processes often vary greatly, and typically are not evidence-based.
designQuasi-experimental study employing pre-/postdesign. Aimed at improving patient-centered discharge processes, we examined the effects of the Discharge Referral Expert System for Care Transitions (DIRECT) algorithm that provides clinical decision support (CDS) regarding which patients to refer to PAC and to what level of care (home care or facility). SETTING AND
participantsConducted in 2 hospitals, DIRECT data elements were collected in the pre-period (control) but discharging clinicians were blinded to the advice and provided usual discharge care. During the postperiod (intervention), referral advice was provided within 24 hours of admission to clinicians, and updated twice daily. Propensity modeling was used to account for differences between the pre-/post patient cohorts. MEASURES: Outcomes compared between the control and the intervention periods included PAC referral rates, patient characteristics, and same-, 7-, 14-, and 30-day readmissions or emergency department visits.
resultsAlthough 24%-25% more patients were recommended for PAC referral by DIRECT algorithm advice, the proportion of patients receiving referrals for PAC did not significantly differ between the control (3302) and intervention (5006) periods. However, the characteristics of patients referred for PAC services differed significantly and inpatient readmission rates decreased significantly across all time intervals when clinicians had DIRECT CDS compared with without. There were no differences observed in return emergency department visits. Largest effects were observed when clinicians agreed with the algorithm to refer (yes/yes). CONCLUSIONS/IMPLICATIONS: Our findings suggest the value of timely, automated, discharge CDS for clinicians to optimize PAC referral for those most likely to benefit. Although overall referral rates did not change with CDS, the algorithm may have identified those patients most in need, resulting in significantly lower inpatient readmission rates.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.