Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain)

Doñate-Martínez, Ascensión; Ferrer, Jorge Garcés; Rigla, Francisco Ródenas

doi:10.1016/j.archger.2014.06.004

Cited by 13 publications

(26 citation statements)

References 27 publications

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“…The Identification of Seniors at Risk (ISAR) is a brief self‐reporting questionnaire developed to identify older persons (65 years of age and above) at risk for mortality, functional decline, readmission, and institutionalisation, widely used and internationally validated …”

Section: Introductionmentioning

confidence: 99%

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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Summary Background Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. Material and methods We prospectively assessed every 4 days (t0) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. Results Twenty‐five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty‐four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. Conclusions Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.

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Section: Introductionmentioning

confidence: 99%

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

et al. 2018

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“…Factors influencing implementation: remote access to anonymised or raw data; privacy and data governance; separation of service planners to patients; complexity/simplicity of the sign up process to gain access to the tool; provision for end user feedback to improve tool; end user friendly interface; integration of social care data when tool is to be used for care integration. 19 Knutson …”

Section:  Successes and Failuresmentioning

confidence: 99%

“…Here again, there was a broad distinction between studies of settings and interventions that included the delivery of primary care and those starting from hospital settings, the closed environment of the Kaiser Permanente system or centralised claims data. The latter showed little or no concern with the active support of clinicians [8,17,19,30] . Every study involving primary care, especially general practice, saw the engagement of clinicians as the key to success.…”

Section:  Successes and Failuresmentioning

confidence: 99%

“…[19] Both of these tools, when used off-the-shelf, were designed to be fulfilled either by post or telephone interview (Pra) or by interview with medical staff (CARS). The Valencia health service trialled using administrative data to populate the tools, supplemented by two self-report items in the case of the Pra tool.…”

Section:  Scottish Patients At Risk Of Readmission and Admission (Spmentioning

confidence: 99%

“…A Valencia study [19] , on the use of risk stratification tools within a chronic disease management program (the Sustainable Social and Healthcare Model) drew participants from three local health departments. This program was based primarily on hospital avoidance and made successful use of centralised administrative data to stratify patients, drawing directly from hospital and clinical information systems, rather than the usual telephone or interview methods used with CARS and Pra.…”

Section:  Data and The Toolmentioning

confidence: 99%

See 2 more Smart Citations

Implementing system-wide risk stratification approaches: A review of critical success and failure factors

Schneider

Gillespie

Wilson

2017

Health Serv Manage Res

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Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both

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Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)

Doñate-Martínez

Ródenas

Garcés

2016

Archives of Gerontology and Geriatrics

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Application of screening tools to detect risk of hospital readmission in elderly patients in Valencian Healthcare System (VHS) (Spain)

Cited by 13 publications

References 27 publications

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital

Implementing system-wide risk stratification approaches: A review of critical success and failure factors

Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain)

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