Follow-up study of chronically ill patients discharged from hospitals.

LDNGTERM illness tests severely the ability of patients and families to look after themselves and of communities to supply the necessary therapeutic and supportive services. Something is known about how patients are cared for in hospitals but much less about how they fare when they are discharged, often to fend for themselves. In order to gain some insight into the nature and magnitude of this problem a study was made of 82 patients before and after discharge from the ward services of three general hospitals in the Boston Metropolitan Area. The selection of cases and their medical apprisal were entrusted to a resident or a visiting physician. Patients were chosen from one of three categories of illness of specified severity as follows: (a) heart disease with a maximum functional capacity of II, or a maximum therapeutic classification of C§[l]; (b) rheumatoid arthritis sufficiently disabling to make it difficult or impossible for the patient to pursue the normal activities of the patient’s age, sex, and physical development [2]; and (c) diabetes requiring at least 30 units of insulin a day for its control. Patients who fell into these three categories of illness were selected in the order in which they were discharged until the monthly quota for each hospital was met. To make follow-up easier, only persons who lived within the limits of the Metropolitan Area were included. At the time of discharge from hospital, each patient was evaluated by the study physician who completed a schedule which, in addition to the usual personal and medical data, included an estimate of the patient’s disability in terms of his capacity to work or carry out the activities of daily living; a description of medical and allied services recommended for a period of 3 months following discharge; and a list of referrals made, specifying the agencies involved. An important stipulation was that the study physician discuss fully with each patient the recommendations for care