Clinical utility of scores on the Blaylock Risk Assessment Screen (BRASS): An analysis of administrative data.

PURPOSE: Project was undertaken to examine the utility of the Blaylock Risk Assessment Screen (BRASS) in identifying patients who may experience discharge complications as indicated by longer hospital stays or readmission within 30-days of a discharge to home. BACKGROUND: Before measures can be put in place to facilitate discharge planning and to prevent unplanned readmission by recently discharged patients, those at risk of such events must be identified. METHODS: Project involved an analysis of 13-months of administrative data from one tertiary care hospital. Utility of the BRASS was examined in terms of its sensitivity and specificity as well as its positive and negative predictive values. RESULTS: Majority (83%) of hospital discharges were to home. Approximately 7% of patients experienced at least one readmission within 30-days of being discharged to home. Using scores of 10 or higher as an indicator of risk, BRASS exhibited a high degree of specificity suggesting it is useful for 'ruling in' those who have the outcomes-of-interest. However low sensitivity indicates many who experienced the outcomes were incorrectly classified by the BRASS as low risk. The low positive predictive value for 30-day readmission also suggests many who were classified by the BRASS as being 'at risk' were not readmitted. CONCLUSION: The observed rate of 30-day readmission is likely conservative as the analysis involved data from only one acute care facility. One explanation for the low positive predictive value for 30-day readmission is that completion of the BRASS on admission enabled the implementation of preventive measures.

A partnership model evolves from a living inventory of engagement.

This university-community partnership developed when practitioners at a community health centre within a regional health authority collaborated with nursing faculty at the University of New Brunswick in Saint John, New Brunswick, Canada. A philosophical match and work context facilitated this collaboration. Partners acknowledged that continued maintenance of the partnership, or its termination, was dependent on the acceptance of principles of partnership engagement. Even though the common philosophy of primary healthcare brought these partners together and reciprocal capacity building was the glue that nurtured their partnership, the tensions that arose fuelled its continued growth and development. Roles and responsibilities of members were discerned and space was created to acknowledge and integrate the lessons learned when tensions were examined. Within this environmental context, a model of partnership emerged. Tensions within this model were accepted as opportunities that resulted in beliefs being challenged, relevant questions generated and partnership alliances strengthened. In this spiral process, new relevant knowledge was constructed and new norms for best practice and policy were developed. The utility of this inter-professional Partnership Model: Living Inventory of Engagement is demonstrated through case examples.