title: The Higher Care At Discharge Index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge.
abstract: A screening index, administered at admission, can be useful in identifying older hospitalised patients at risk of requiring a higher level care at discharge. The objective of this study was to describe the development of a risk stratification index for allocating patients into lower and higher risk of requiring higher level care at discharge. A prospective cohort study of general medical patients, aged ≥70 years admitted to three metropolitan acute care hospitals in Brisbane, Australia was conducted. Derivation cohort (n=360) was used to: identify significant predictive factors associated with discharge to a higher level care; and develop a screening index to stratify patients into lower and higher risk. Predictive performance of the index was examined in the validation cohort (n=142). Five independent factors associated with requiring higher level care (identified using stepwise logistic regression analysis) were used to develop the HCDI: no support person to assist with living in the community; received assistance with finances; received assistance with hygiene; short term memory problems; hospitalised in 90 days prior to current hospital admission. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the dichotomised risk scores of the HCDI were: 76.3%; 73.3%; 36.0%; and 94.0% respectively; correctly classified 73.8%. In the validation cohort, sensitivity was 81.8%; specificity 68.7%; PPV 18.0%; NPV 97.8%, correctly classified 69.7%. Requirement for a higher level care at discharge has important consequences for health service delivery. The HCDI can be used to identify patients at higher risk.
authors.affiliation: Centre for Research in Geriatric Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Ipswich Rd., Woolloongabba, Brisbane 4102, Australia. p.ramritu@uq.edu.au
authors.forename: Prabha
authors.initials: P
authors.lastname: Lakhan
authors.forename: Mark
authors.initials: M
authors.lastname: Jones
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Gray
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors