Screening by Social Workers in Medical Patients with Risk of Post-Acute Care Needs: A Stepped Wedge Cluster Randomized Trial / Evaluation eines Screenings durch Sozialarbeiter bei medizinischen Patienten mit einem Risiko für post-akuten Nachsorgebedarf: eine stepped wedge clusterrandomisierte Studie
Published Online: Apr 25, 2018
Page range: 25 - 34
Received: Jan 05, 2017
Accepted: Dec 22, 2017
DOI: https://doi.org/10.2478/ijhp-2018-0003
Keywords
© 2018 Antoinette Conca, Doaa Ebrahim, Sandra Noack, Angela Gabele, Helen Weber, Mehrnaz Prins, Anja Keller, Mariann Hari, Angela Engel, Katharina Regez, Ursula Schild, Philipp Schuetz, Beat Müller, Sebastian Haubitz, Alexander Kutz, Andreas Huber, Lukas Faessler, Petra Schäfer-Keller
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Background
Elderly patients often need post-acute care after hospital discharge. Involvement of social workers can positively affect the discharge planning process.
Aim
To investigate the effect of screening patients at risk for post-acute care needs by social workers on time with respect to social workers’ notification, length of stay and delays in discharge compared to usual care.
Methods
Cluster randomized stepped wedge trial design for five clusters (wards) and two steps (control to intervention) was used. A total of 400 patients (200 per period) with high risk of post-acute care needs (defined as Post-Acute Care Discharge score, PACD ≥ 7) were included. Social workers performed a screening to decide about self-referral to their services (intervention period), which was compared to a highly structured standard SW notification by physicians and nurses (control period). A Generalized Estimating Equations model adjusted the clustering and baseline differences.
Results
A total of 139 patients were referred to social services (intervention: n = 76; control: n = 63). Time to social workers’ notification was significantly shorter in the intervention period when adjusted for all the differences in baseline (Mdn 1.2 vs 1.7, Beta = -0.73, 95%-CI 1.39 to -0.09). Both the length of stay and the delayed discharge time in nights showed no significant differences (Mdn 10.0 vs 9.1, Beta = -0.12, 95%-CI 0.46 to .22 nights 95%-CI, resp. Mdn 0.0 vs 0.0, Beta = .11, 95%-CI -0.64 to 0.86).
Conclusion
Screening speeded up social workers’ notification but did not accelerate the discharge processes. The screening by social workers might show process improvement in settings with less structured discharge planning.