Shared Decision Making in Discharge Planning and Long-Term Care Linkage: A Retrospective Study

Objectives To evaluate the impact of shared decision making (SDM) on successful long-term care (LTC) service utilization and early readmissions among high-risk hospitalized patients. Design This retrospective observational study employed a standardized SDM decision aid during discharge planning to guide collaborative discussions about postdischarge care options among patients, family caregivers, and health care providers. Setting and Participants Conducted at a medical center in central Taiwan, the study included 436 patients referred for discharge planning between November 2022 and December 2023. All participants had Activities of Daily Living (ADL) scores ≤65. Patients were grouped based on whether SDM was used (SDM group, n = 72; non-SDM group, n = 364). Methods Data were collected from electronic medical records and national care databases. Primary outcomes were LTC integration and 14-day hospital readmissions. Secondary outcomes included hospital stay duration, 15-30-day readmissions, and 3-month survival. Within 7 days of discharge, nursing staff conducted telephone follow-ups to assess patient and/or family satisfaction with discharge-planning information from the nursing and medical teams (0-100 scale). For institutional discharges, satisfaction with the LTC facility was also recorded. Analyses involved χ² tests, logistic regression, and propensity score matching to control for baseline differences. Results The SDM group achieved higher LTC integration (95.4% vs 82.7%, P < .001) and greater satisfaction with discharge planning. Within SDM, only nonadherent participants were readmitted by 14 days (7/7; P < .001), whereas adherent participants had none. No significant differences were found in hospital stay, 15-30-day readmissions, or 3-month survival after adjustment. Seven days after discharge, satisfaction was higher in the SDM group for the nursing staff, medical team, and, when applicable, LTC institutions. Conclusions and Implications SDM was associated with higher linkage to LTC services and directionally higher discharge-planning satisfaction. After adjustment, 14-day readmission rates were similar between SDM and non-SDM. Within the SDM subgroup, nonadherence to the SDM plan was associated with early readmission. Although it did not affect long-term outcomes or hospital stay duration, SDM enhanced patient-centered care and discharge satisfaction. Early and widespread implementation of SDM may support safer and more coordinated transitions for high-risk patients.