Screening for risk of unplanned readmission in older patients admitted to hospital: predictive accuracy of three instruments.
OBJECTIVE
Hospital readmission after discharge is an important clinical and health policy issue. We compared the predictive accuracy of the Identification of Seniors at Risk (ISAR), the Flemish version of the Triage Risk Screening Tool (TRST) and Variable Indicative of Placement risk (VIP) in assessing unplanned readmissions.


METHODS
We included 213 patients (≥65 years), hospitalized following admission to the emergency department. The ISAR, TRST and VIP were administered at admission. Unplanned readmissions were registered by telephone follow-up 14, 30 and 90 days post-discharge.


RESULTS
Unplanned readmission rates were 6.8%, 14.7% and 23.5% after 14, 30, and 90 days, respectively. The ISAR showed low to moderate sensitivity (54%-69%) and a high negative predictive value (≥78%) at all measurement points. Specificity and positive predictive value were low (≤33% and ≤24%, respectively). The TRST had low to moderate sensitivity (42%-67%) and a high negative predictive value (≥82%). Specificity and positive predictive value were low (≤45% and ≤27%, respectively). The VIP had very low sensitivity (≤26%) and high specificity (≥80%). Its negative predictive value was high (≥79%) and its positive predictive value was low (≤22%).


CONCLUSIONS
Due to their moderate to low sensitivity, and low specificity and positive predictive value, none of the instruments was capable of accurately predicting unplanned readmission in older, hospitalized patients. Overall, reducing or increasing the original cut-off value by one point did not result in improved performance. Our findings suggest that these instruments lack the necessary sophistication to capture the complexity of (unplanned) readmissions.
Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
Tom
T
Braes
Philip
P
Moons
Piet
P
Lipkens
Wendy
W
Sterckx
Marc
M
Sabbe
Johan
J
Flamaing
Steven
S
Boonen
Koen
K
Milisen
D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D014218:Triage / Q000706:statistics & numerical data