Abstract
OBJECTIVE: Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.
DESIGN: Retrospective cohort study.
SETTING: The risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.
PARTICIPANTS: The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017-2018.
MEASURES: The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden's index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.
RESULTS: The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.
CONCLUSION: The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.
| Original language | English |
|---|---|
| Article number | e070559 |
| Number of pages | 16 |
| Journal | BMJ Open |
| Volume | 13 |
| Issue number | 8 |
| DOIs | |
| Publication status | Published - 3 Aug 2023 |
Bibliographical note
Publisher Copyright:© 2023 BMJ Publishing Group. All rights reserved.
Funding
This study was supported by a grant from the ALF funding from Region Skåne, awarded to PM. The study was further supported by doctoral grants from the Research and Development Committee at Kristianstad-Hässleholm Hospitals and the Southern Medical Care Region, awarded to MG. The funding body had no role in the design of the study, the collection, analysis or interpretation of data or in writing the manuscript.
| Funders | Funder number |
|---|---|
| Southern Medical Care Region | |
| Region Skåne |
Keywords
- geriatric medicine
- health & safety
- quality in health care
- risk management