Medical Inpatients at Risk of Extended Hospital Stay and Poor Discharge Health Status: Detection With COMPRI and INTERMED

Objective: To detect the patients in medical wards at risk of extended LOS and poor discharge health status with the use of complexity prediction instrument (COMPRI) and interdisciplinary medicine (INTERMED) instruments. Methods: Study 1: In a sample of 275 consecutively admitted medical inpatients, a hierarchical cluster analysis on INTERMED variables was performed. The clusters were compared on length of hospital stay (LOS) and Short Form 36 (SF-36) at discharge. Study 2: Receiver operating characteristic (ROC) analysis was used to optimal cut-off points for the COMPRI and INTERMED. Patients detected with COMPRI and INTERMED were then compared with undetected patients on LOS and SF-36. Results: Study 1: In concordance with previous findings, a cluster of patients with high biopsychosocial vulnerability was identified with significantly higher scores on LOS (p .05) and lower scores on SF-36 (p .001) than patients in other clusters. Study 2: A cut-off point for the COMPRI of 5/6 was found to detect patients at risk of long LOS. A cut off score for the INTERMED of 20/21 was found to detect patients at risk of poor discharge health status. Patients detected with COMPRI and INTERMED had a significantly longer LOS (p .001) and a poorer discharge health status (SF-36 MCS: p .001; SF-36 PCS: p .05) than nondetected patients. Of the detected patients, 37 % had an extended hospital stay and poor discharge health status; of the nondetected patients, this was only 7%. Conclusions: The COMPRI-INTERMED can help to detect complex patients admitted to medical wards within the first days of admission, and rule out those with a small chance of poor outcomes. Key words: internal medicine, psychiatric, COMPRI, INTERMED, SF-36, length of stay, health status, quality of life. COMPRI Complexity prediction instrument; INTERMED interdisciplinary medicine; ROC receiver operating characteristic; AUC area under the curve; LOS length of hospital stay; SF-3