Assessment tool for hospital admissions related to medications: development and validation in older patients

Abstract

Background Medication-related hospital admissions (MRAs) are frequently used to measure outcomes in studies involving medication reviews. The process of identifying MRAs is subjective and time-consuming, and practical, validated alternatives are required. Objective The aim of this study was to develop and validate a practical tool to identify MRAs. Setting Uppsala University Hospital, Sweden. Method We reviewed existing literature on methods to identify MRAs. The tool AT-HARM10 was developed using an iterative process including content validity and feasibility testing. The tool’s inter-rater reliability (IRR) and criterion-related validity (CRV) were assessed: four pairs of either final-year undergraduate or postgraduate pharmacy students applied the tool to one of two batches of 50 older patients’ hospital admissions. Assessment of the same 100 admissions by two experienced clinicians acted as gold standard. Main outcome measure Cohen’s and Fleiss’ kappa for IRR, and sensitivity, specificity, and positive and negative predictive value for CRV. Results AT-HARM10 consists of ten closed questions to distinguish between admissions that are unlikely to be and those that are possibly medication-related. The IRR was moderate to substantial (Cohen’s kappa values were 0.45–0.75 and Fleiss’ kappa values were 0.46 and 0.58). The sensitivity and specificity values were 70/86% and 74/70%, positive and negative predictive values were 73/74% and 71/83% respectively. Both AT-HARM10 and the gold standard identified approximately 50% of the admissions as MRAs. Conclusion AT-HARM10 has been developed as a practical tool to identify MRAs and the tool is valid for use in older patients by final-year undergraduate and postgraduate pharmacy students. Electronic supplementary material The online version of this article (10.1007/s11096-018-0768-8) contains supplementary material, which is available to authorized users.

Medication-related hospital readmissions within 30 days of discharge—A retrospective study of risk factors in older adults

“… Abbreviations: MRP–Medication-Related Problem, i.e.–“id est” meaning “that is”, e.g.–“exempli gratia” meaning “for example”. a According to the assessment tool AT-HARM10 [ 25 ]. …”

“…In the current study, the patients readmitted within 30 days (n = 360) were assessed as being either possibly or unlikely medication-related readmissions. The assessment was made with the help of the Assessment Tool for identifying Hospital Admissions Related to Medicine (AT-HARM10) [ 25 ]. In this assessment tool, a medication-related (re-)admission is defined as a hospital admission where a medication-related problem is either the main admission cause or significantly contributes to admission.…”

“…The assessment of the readmissions’ relation to medication, according to the assessment tool AT-HARM10 [ 25 ], was performed by the first author (MG) in an un-blinded fashion. The assessment tool is comprised of 10 questions, as seen in S1 Appendix .…”

Content Validation through Expert Judgement of an Instrument on the Nutritional Knowledge, Beliefs, and Habits of Pregnant Women

“…Given that there were multiple raters in this study, the Fleiss' κ statistic was used, as it is based on the agreement between different pairs of raters, which increases the accuracy of the results [35,[56][57][58], unlike the weighted Cohen's κ statistic, which is used for nominal variables in the case of two raters [59].…”

Identifying medication‐related readmissions: Two students using tools vs a multidisciplinary panel

“…Recently, two tools have been developed to identify MRRs in hospitals: the Assessment Tool for identifying Hospital Admissions Related to Medications (AT-HARM10) and the drug-related admission (DRA) adjudication guide. 10,11 AT-HARM10 tool is a validated tool that includes ten yes or no questions to determine whether admission is medication-related. 10 An example of a question of the AT-HARM10 tool is: "Are there abnormal laboratory results or vital signs that could be medicationrelated and might have caused the admission?…”