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From Department of Psychiatry (P.D.J., I.B., F.J.H., C.H.M.L.), Vrije Universiteit Medical Center, Amsterdam; and Department of Social Psychiatry (P.D.J.), University of Groningen, Groningen, The Netherlands.
Peter de Jonge, PhD, Department of Social Psychiatry, Hanzeplein 1, Gebouw 32, PO Box 30.001, 9700RB Groningen, The Netherlands. E-mail: p.de.Jonge{at}med.rug.nl
Received for publication July 1, 2002; revision received December 9, 2002.
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.
Abbreviations: COMPRI = Complexity prediction instrument;; INTERMED = interdisciplinary medicine;; ROC = receiver operating characteristic;; AUC = area under the curve;; LOS = length of hospital stay;; SF-36 = Short Form 36;; SPSS = Statistical Package for the Social Sciences;; PCS = SF-36 Physical Health Component Score;; MCS = SF-36 Mental Health Component Score
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