[Development of a tool for the identification of socially vulnerable hospital patients].
OBJECTIVE
To develop and assess the metrological properties of a simple to use tool to identify socially vulnerable outpatients.


METHODS
A multidisciplinary group of professionals selected five characteristics identifying social vulnerability, integrated in a self-reported questionnaire, from which 5 criteria identify the socially vulnerable outpatients consulting the hospital. The metrological performance of the tool was assessed on a sample of randomly selected outpatients admitted to the emergency department and the results referred to the independent assessment of two social workers. The sensitivity and specificity of the tool were determined and ROC curves drawn.


RESULTS
222 patients were included, aged from 15 to 93 Years (mean: 53 Years), 59% of whom were men. 78% filled out the questionnaire on their own, while 22% required help, usually for physical or material reasons and 87% answered the five questions without any difficulty. The kappa coefficient of agreement between the two social workers was estimated at 0.94 (CI: 0.89-0.98). The sensitivity of the self reported questionnaire was of 70% (CI: 64-76) and its specificity of 77% (CI: 71-82). The ROC curves showed that the modified tool had a sensitivity of 80% (Sp: 67%). With only 2 characteristics, this sensitivity was of 76% (Sp: 73%).


CONCLUSIONS
This tool, which is based on the advice of various experts, is valid and presents acceptable metrological properties. Once some simplifications have been made, the questionnaire could be used in routine in any patient consulting the hospital because it is acceptable, simple to use and can be rapidly filled-in.
Pascal
Jean
J
Laboratoire de santé publique et d'épidémiologie, Pôle d'information médicale, d'évaluation et de santé publique, Hôpital Saint-Jacques, CHU de Nantes. jean.pascal@chu-nantes.fr
Abbey-Huguenin
Hélène
H
Agard
Christian
C
Asseray
Nathalie
N
Billaud
Eric
E
Baron
Denis
D
Lombrail
Pierre
P
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D010045:Outpatients / Q000706:statistics & numerical data; D011594:Psychometrics; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012947:Social Work; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires / Q000592:standards*; D035862:Vulnerable Populations / Q000706:statistics & numerical data