OBJECTIVES To describe and validate the Post-acute Delayed Discharge Risk Scale (PADDRS), which classifies patients by risk of delayed discharge on admission to post-acute care settings using information collected with the interRAI Minimum Data Set (MDS) 2.0 assessment. DESIGN Retrospective cohort study of individuals admitted to Ontario Complex Continuing Care (CCC) hospitals. Person-level linkage between interRAI MDS 2.0 assessments and Cancer Care Ontario Wait Time Information System records was performed. SETTING AND PARTICIPANTS Sample of 30,657 patients who received care in an Ontario CCC hospital and were assessed with the interRAI MDS 2.0 assessment between January 1, 2010, and March 31, 2013. MEASURES Alternate Level of Care (ALC) designation of 30 or more days was used as the marker of delayed discharge. Scale validation was performed through computation of class-level effect sizes and receiver operating characteristic curves for each of Ontario's geographic health regions. Additionally, Clinical Assessment Protocol (CAP) decision-support tool trigger rates by PADDRS risk level were computed for problem areas that are clinically relevant with the delayed discharge outcome. RESULTS Overall, 9.4% of the sample experienced the delayed discharge outcome. The PADDRS algorithm achieved an overall area under the curve (AUC) statistic of 0.74, which indicates good discriminatory ability for predicting delayed discharge. PADDRS is generalizable across geographic regions, with AUC statistics ranging between 0.61 and 0.81 across each of Ontario's 14 Local Health Integration Networks. PADDRS demonstrated strong concurrent validity, as the percentage of patients triggering CAP increased with the risk of delayed discharge. CONCLUSIONS AND IMPLICATIONS PADDRS combines numerous important clinical factors associated with delayed discharge form a post-acute hospital into a cohesive decision-support tool for use by discharge planners. In addition to early identification of patients who are most likely to experience delayed discharge, PADDRS has applications in risk-adjusted quality measurement of discharge planning efficiency.

中文翻译：

---

急性延迟出院风险量表：安大略综合持续护理医院中安大略替代护理水平患者的推导和验证

目的 描述和验证急性后延迟出院风险量表 (PADDRS)，该量表使用通过 interRAI 最小数据集 (MDS) 2.0 评估收集的信息，根据入院时延迟出院的风险对患者进行分类。设计 安大略综合持续护理 (CCC) 医院住院患者的回顾性队列研究。进行了 interRAI MDS 2.0 评估和安大略癌症护理等待时间信息系统记录之间的个人级链接。设置和参与者 2010 年 1 月 1 日至 2013 年 3 月 31 日期间在安大略省 CCC 医院接受护理并使用 interRAI MDS 2.0 评估进行评估的 30,657 名患者样本。 测量 30 天或更长时间的替代护理水平 (ALC) 指定被用作延迟放电的标志。规模验证是通过计算安大略省每个地理健康区域的等级效应大小和接收者操作特征曲线来进行的。此外，针对与延迟出院结果临床相关的问题区域，计算了 PADDRS 风险级别的临床评估协议 (CAP) 决策支持工具触发率。结果 总体而言，9.4% 的样本经历了延迟出院结果。PADDRS 算法的总曲线下面积 (AUC) 统计量为 0.74，这表明预测延迟放电具有良好的判别能力。PADDRS 可跨地理区域推广，安大略省 14 个地方健康整合网络中的每一个的 AUC 统计数据范围在 0.61 到 0.81 之间。PADDRS 表现出很强的并发有效性，因为触发 CAP 的患者百分比随着延迟出院的风险而增加。结论和意义 PADDRS 将许多与急症后医院延迟出院相关的重要临床因素结合成一个有凝聚力的决策支持工具，供出院计划者使用。除了早期识别最有可能出现延迟出院的患者外，PADDRS 还应用于出院计划效率的风险调整质量测量。