Quality Issues in Discharge Planning

The Medicare and Medicaid laws were intended to eliminate inferior medical care for the elderly and the indigent. The success of these programs, however, has led to more expense than the government had anticipated. To control this cost, the government has designed several utilization review processes that, by necessity, have also required quality assurance mech anisms. On the assumption that fewer hospital days would cost fewer dollars, discharge planning has evolved. Although physicians may find this somewhat time consuming, they must participate in discharge planning because of the consumers' demand, the legal requirement, the attempt to reduce litigation, and the potential income. All patients need discharge plan ning to some extent. The evaluation of the quality of discharge planning must look at its structure, its process, and its outcome. Most early studies seem to be looking at the in-hospital process, but we must also evaluate process-centered, patient-centered, commu nity-centered, and cost effec...