Abstract
This paper describes the construction of a graphical decision tool to aid placement decisions of a multidisciplinary review panel for admissions to long-term care in a London borough in the UK. First we construct a prediction model of placement decisions based on an applicant's attributes. Using data from the London borough, a composite model comprising syndromic decision rules followed by a two-stage hierarchical logistic regression model is proposed. The model proved to be robust in differentiating cases needing residential home care and nursing home care. Placement outcomes generated by the model are then represented graphically on a triangle plot. This approach could potentially be used as a decision support tool by managers of long-term care for continuous monitoring and assessment of the appropriateness of placements with respect to residents’ needs.
Similar content being viewed by others
References
Challis D et al (2000). Dependency in older people recently admitted to care homes. Age and Ageing 29: 255–260.
Coxeter HSM (1969). Introduction to Geometry, 2nd edn. Wiley: New York.
Efron B and Tibshirani R (1993). An Introduction to the Bootstrap. Chapman & Hall: New York.
Everitt BS (1968). Moments of the statistics kappa and weighted kappa. Br J Math Stat Psychol 21: 97–103.
Hanley JA and McNeil BJ (1982). The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143: 29–36.
Harrell FE et al (1984). Regression modelling strategies for improved prognostic prediction. Stat Med 3: 143–152.
Harrell FE (2001). Regression Modelling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis. Springer-Verlag: New York.
Hosmer DW and Lemeshow S (2000). Applied Logistic Regression, 2nd edn. Wiley: New York.
Le Cessie S and van Houwelingen JC (1991). A goodness-of-fit test for binary regression models, based on smoothing methods. Biometrics 47: 1267–1282.
Mehta CR and Patel NR (1995). Exact logistic regression: theory and examples. Stat Med 14: 2143–2160.
National Audit Office (2003). Ensuring the Effective Discharge of Older Patients from NHS Acute Hospitals. The Stationery Office: London.
Newnham DM, Berrington A, Primrose WR and Seymour DG (1996). Self funding and community care admissions to nursing homes in Aberdeen. Health Bull 54: 301–306.
Pelletier C, Chaussalet TJ and Xie H (2005). A framework for predicting gross institutional long-term care cost arising from known commitments at local authority level. J Opl Res Soc 56: 144–152.
Primrose WR, Mukherjee D, Newton H and Howard D (1998). Community institutional care for frail elderly people. BMJ 316: 780.
Primrose WR, Hamilton BA and Muir KT (1999). Long stay care and the NHS—multidisciplinary assessment is needed. BMJ 318: 668.
Rothera I et al (2003). Health status and assessed need for a cohort of older people admitted to nursing and residential homes. Age and Ageing 32: 303–309.
Rowland DR and Pollock AM (2004). Choice and responsiveness for older people in the “patient centred” NHS. BMJ 328: 4–5.
Turrell AR, Castleden CM and Freestone B (1998). Long stay care and the NHS: discontinuities between policy and practice. BMJ 317: 942–944.
Victor C, Hastie IR, Christodoulou G and Millard PH (2001). The inappropriate placement of older people in nursing homes in England and Wales: a national audit. Quality in Ageing—Policy, Practice and Research 2: 16–25.
Xie H, Chaussalet TJ, Thompson WA and Millard PH (2002). Modelling decisions of a multidisciplinary panel for admission to long-term care. Health Care Mngt Sci 5: 291–295.
Xie H, Chaussalet TJ and Millard PH (2005). A continuous-time Markov model for the length of stay of elderly people in institutional long-term care. J R Statist Soc A 168: 51–61.
Acknowledgements
We thank Dr Ian Hastie, St. George's Hospital, and the late Mr Terry Bucher, Housing and Social Services, London Borough of Merton, for granting permission to consult case notes. This work was partly supported by funding from the Peel Trust and the Engineering and Physical Sciences Research Council (GR/R86430/01).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Xie, H., Chaussalet, T., Thompson, W. et al. A simple graphical decision aid for the placement of elderly people in long-term care. J Oper Res Soc 58, 446–453 (2007). https://doi.org/10.1057/palgrave.jors.2602179
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1057/palgrave.jors.2602179