title: Stratification of risk for hospital admissions for injury related to fall: cohort study.
abstract: OBJECTIVE
  To determine whether the ability to stratify an individual patient's hazard for falling could facilitate development of focused interventions aimed at reducing these adverse outcomes.
  
  
  METHODS
  Clinical and sociodemographic data from electronic health records were utilized to derive multiple logistic regression models of hospital readmissions for injuries related to falls. Drugs used at admission were summarized based on reported adverse effect frequencies in published drug labeling.
  
  
  METHODS
  Two large academic medical centers in New England, United States.
  
  
  METHODS
  The model was developed with 25,924 individuals age ≥ 40 with an initial hospital discharge. The resulting model was then tested in an independent set of 13,032 inpatients drawn from the same hospital and 36,588 individuals discharged from a second large hospital during the same period.
  
  
  METHODS
  Hospital readmissions for injury related to falls.
  
  
  RESULTS
  Among 25,924 discharged individuals, 680 (2.6%) were evaluated in the emergency department or admitted to hospital for a fall within 30 days of discharge, 1635 (6.3%) within 180 days of discharge, 2360 (9.1%) within one year, and 3465 (13.4%) within two years. Older age, female sex, white or African-American race, public insurance, greater number of drugs taken on discharge, and score for burden of adverse effects were each independently associated with hazard for fall. For drug burden, presence of a drug with a frequency of adverse effects related to fall of 10% was associated with 3.5% increase in odds of falling over the next two years (odds ratio 1.04, 95% confidence interval 1.02 to 1.05). In an independent testing set, the area under the receiver operating characteristics curve was 0.65 for a fall within two years based on cross sectional data and 0.72 with the addition of prior utilization data including age adjusted Charlson comorbidity index. Portability was promising, with area under the curve of 0.71 for the longitudinal model in a second hospital system.
  
  
  CONCLUSIONS
  It is potentially useful to stratify risk of falls based on clinical features available as artifacts of routine clinical care. A web based tool can be used to calculate and visualize risk associated with drug treatment to facilitate further investigation and application.
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Castro
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: McCoy
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Cagan
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA.
authors.forename: Hannah R
authors.initials: HR
authors.lastname: Rosenfield
authors.affiliation: Partners Research Computing, Partners HealthCare System, One Constitution Center, Boston, MA 02129, USA Laboratory of Computer Science and Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Shawn N
authors.initials: SN
authors.lastname: Murphy
authors.affiliation: Information Systems, Partners HealthCare System, New Research Building 255, 77 Avenue Louis Pasteur, Boston, MA 02115, USA.
authors.forename: Susanne E
authors.initials: SE
authors.lastname: Churchill
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Suite 255, New Research Building, 77 Avenue Louis Pasteur, Boston, MA 02115, USA.
authors.forename: Isaac S
authors.initials: IS
authors.lastname: Kohane
authors.affiliation: Center for Experimental Drugs and Diagnostics, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 20114, USA Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Simches Research Building 6th Floor, 185 Cambridge St, Boston, MA 02114, USA rperlis@partners.org.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Perlis
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003661:Decision Support Techniques; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009511:New England; D016017:Odds Ratio; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014947:Wounds and Injuries / Q000209:etiology* / Q000628:therapy