title: Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: the elders risk assessment index.
abstract: BACKGROUND
  The prevention of recurrent hospitalizations in the frail elderly requires the implementation of high-intensity interventions such as case management. In order to be practically and financially sustainable, these programs require a method of identifying those patients most at risk for hospitalization, and therefore most likely to benefit from an intervention. The goal of this study is to demonstrate the use of an electronic medical record to create an administrative index which is able to risk-stratify this heterogeneous population.
  
  
  METHODS
  We conducted a retrospective cohort study at a single tertiary care facility in Rochester, Minnesota. Patients included all 12,650 community-dwelling adults age 60 and older assigned to a primary care internal medicine provider on January 1, 2005. Patient risk factors over the previous two years, including demographic characteristics, comorbid diseases, and hospitalizations, were evaluated for significance in a logistic regression model. The primary outcome was the total number of emergency room visits and hospitalizations in the subsequent two years. Risk factors were assigned a score based on their regression coefficient estimate and a total risk score created. This score was evaluated for sensitivity and specificity.
  
  
  RESULTS
  The final model had an AUC of 0.678 for the primary outcome. Patients in the highest 10% of the risk group had a relative risk of 9.5 for either hospitalization or emergency room visits, and a relative risk of 13.3 for hospitalization in the subsequent two year period.
  
  
  CONCLUSIONS
  It is possible to create a screening tool which identifies an elderly population at high risk for hospital and emergency room admission using clinical and administrative data readily available within an electronic medical record.
authors.affiliation: Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA. crane.sarah@mayo.edu
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Crane
authors.forename: Ericka E
authors.initials: EE
authors.lastname: Tung
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Hanson
authors.forename: Stephen
authors.initials: S
authors.lastname: Cha
authors.forename: Rajeev
authors.initials: R
authors.lastname: Chaudhry
authors.forename: Paul Y
authors.initials: PY
authors.lastname: Takahashi
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002908:Chronic Disease / Q000628:therapy; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000145:classification / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D016347:Medical Records Systems, Computerized / Q000706:statistics & numerical data*; D008875:Middle Aged; D008910:Minnesota; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment / Q000379:methods*