Integrated postdischarge transitional care in a hospitalist system to improve discharge outcome: an experimental study

Table 1 Disease-specific indicators designated for postdischarge care by telephone call follow-up^a

Disease	Indicator 1	Indicator 2	Indicator 3
Chronic disease with acute change
CHF with acute exacerbation	Body weight	Leg edema^b	Dyspnea index^c
Liver cirrhosis with decompensation	Body weight	Consciousness
COPD with acute exacerbation	Fever	Dyspnea index^c	Sputum character
DM with poor control	Blood glucose
Hypertension with poor control	Blood pressure
Acute on chronic renal failure	Body weight	Urine output
Terminal cancer	Consciousness	Pain scale^d	Dyspnea index^c
Acute illness
Ischemic stroke	Barthel score	Consciousness
UGI bleeding	Stool character	Heart rate
Pneumonia	Fever	Dyspnea index^c
Urinary tract infection	Fever	Dysuria
Cellulitis	Size of lesion	Local pain^d	Fever
Intraabdominal infection	Fever	Abdominal pain^d

^aCHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; UGI, upper gastrointestinal. Blood pressure, body temperature, heart rate and blood glucose were measured by the patients or their caregivers at home. ^bMeasured by grading developed for cancer treatment [26]. ^cMeasured according to the Medical Research Council dyspnea scale [27]. ^dMeasured according to the Numerical Rating Scale [28].

ISSN: 1741-7015