An early warning tool for predicting at admission the discharge disposition of a hospitalized patient.

OBJECTIVES: To develop an early warning discharge disposition prediction tool based on clinical and health services factors for hospitalized patients. Recent study results suggest that early prediction of discharge disposition (ie, whether patients can return home or require placement in a facility) can improve care coordination, expedite care planning, and reduce length of stay. STUDY DESIGN: Retrospective analysis of inpatient data; development of multiple logistic regression model and an easy-to-use score. METHODS: We used retrospective data from all patients who were admitted in 2013 to the general medical service at the Veterans Affairs Boston Healthcare System and discharged alive. A derivation-validation approach was used to build a multiple logistic regression model, which was transformed into a score for potential implementation. RESULTS: Of the 4760 patients discharged in 2013, 485 (10.2%) were discharged to a facility other than home. Correlates of discharge to a facility included a primary admission diagnosis of neoplasm (odds ratio [OR], 2.71; 95% CI, 1.73-4.25), diseases of the nervous system (OR, 2.53; 95% CI, 1.26-5.08), and musculoskeletal diseases (OR, 2.55; 95% CI, 1.52-4.27), as well as discharge to a facility during previous hospitalization. Patients with a prior primary diagnosis of circulatory disorder and those with comorbidity of hypertension, either complicated or uncomplicated, were less likely to be discharged to a facility. A value of 5 or greater on the 20-point scale indicated discharge to a facility with 83% sensitivity and 48% specificity. CONCLUSIONS: A validated, easy-to-use score can assist providers in identifying upon admission those patients who may not be able to go directly home after hospitalization, thus facilitating early discharge planning and coordination, potentially reducing length of hospital stay and improving patient experience.

Effects of sex and reproductive experience on the number of orexin A-immunoreactive cells in the prairie vole brain.

Large populations of cells synthesizing the neuropeptide orexin (OX) exist in the caudal hypothalamus of all species examined and are implicated in physiological and behavioral processes including arousal, stress, anxiety and depression, reproduction, and goal-directed behaviors. Hypothalamic OX expression is sexually dimorphic in different directions in laboratory rats (F>M) and mice (M>F), suggesting different roles in male and female physiology and behavior that are species-specific. We here examined if the number of hypothalamic cells immunoreactive for orexin A (OXA) differs between male and female prairie voles (Microtus ochrogaster), a socially monogamous species that pairbonds after mating and in which both sexes care for offspring, and if reproductive experience influences their number of OXA-immunoreactive (OXA-ir) cells. It was found that the total number of OXA-ir cells did not differ between the sexes, but females had more OXA-ir cells than males in anterior levels of the caudal hypothalamus, while males had more OXA-ir cells posteriorly. Sexually experienced females sacrificed 12 days after the birth of their first litter, or one day after birth of a second litter, had more OXA-ir cells in anterior levels but not posterior levels of the caudal hypothalamus compared to females housed with a brother (incest avoidance prevents sibling mating). Male prairie voles showed no effect of reproductive experience but showed an unexpected effect of cohabitation duration regardless of mating. The sex difference in the distribution of OXA-ir cells, and their increased number in anterior levels of the caudal hypothalamus of reproductively experienced female prairie voles, may reflect a sex-specific mechanism involved in pairbonding, parenting, or lactation in this species.