Predicting the Risk of Hospital Admission in Older Persons—Validation of a Brief Self‐Administered Questionnaire in Three European Countries

Wagner, Jan T.; Bachmann, Lucas M.; Boult, Chad; Harari, Danielle; Renteln-Kruse, Wolfgang von; Egger, Matthias; Beck, John C.; Stuck, Andreas E.

doi:10.1111/j.1532-5415.2006.00829.x

Cited by 45 publications

(40 citation statements)

References 26 publications

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“…Self-rated health is a well-known predictor for adverse outcomes in the elderly. Patient perception of their health status is an important component of the Pra instrument, a widely used geriatric tool that has been validated in several populations [2,3,12,14,15]. Selfrated health is also a component of the Vulnerable Elders Survey, a tool which was originally designed to identify elderly at higher risk of death and functional decline but has also been shown to predict increased health care utilization [16,17].…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Chandra¹,

Crane²,

Tung³

et al. 2015

Aging and disease

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There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year. Key words: emergency department, geriatric screening, hospitalizationAging is associated with a higher burden of disease, disability, and complex medical needs. In order to effectively address these concerns, screening strategies that identify issues that affect the quality of life and health outcomes in the elderly are needed. Health care providers are keenly interested in identifying predictors of adverse health outcomes such as emergency department (ED) visits and hospitalizations in the elderly. This interest, largely due to an increase in the aging population, is further driven by the Affordable Care Act which provides impetus to contain costs and reduce avoidable hospital readmissions [1]. Previous studies have examined predictors for increased health care utilization and adverse outcomes and introduced instruments, which incorporate factors such as medical complexity, self-rated health, previous utilization, and socioeconomic and functional status, to assess this risk in different settings [2][3][4][5][6][7]. Falls, urinary incontinence, vision and hearing difficulties, weight loss, depression, poor memory, and poor self-rate of health are common geriatric issues which deeply affect the qualit...

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Chandra¹,

Crane²,

Tung³

et al. 2015

Aging and disease

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“…One of these studies (n=6924 aged ≥65 years), examined the performance of the original Pra in a randomised controlled trial (RCT) across three European countries (UK, Switzerland and Germany) 17. Similar proportions of patients were classified as high risk, ranging from 4% to 7%, with similar predictive accuracy in different settings (combined sites c-statistic: 0.64 (95% CI 0.62 to 0.66)) 17. Two US community-based studies examined a modified version of the Pra, substituting self-report items (caregiver availability and self-rated health status) for a measure of multimorbidity.…”

Section: Discussionmentioning

confidence: 99%

External validation of the Probability of repeated admission (Pra) risk prediction tool in older community-dwelling people attending general practice: a prospective cohort study

et al. 2016

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ObjectivesEmergency admission is associated with the potential for adverse events in older people and risk prediction models are available to identify those at highest risk of admission. The aim of this study was to externally validate and compare the performance of the Probability of repeated admission (Pra) risk model and a modified version (incorporating a multimorbidity measure) in predicting emergency admission in older community-dwelling people.Setting15 general practices (GPs) in the Republic of Ireland.Participantsn=862, ≥70 years, community-dwelling people prospectively followed up for 2 years (2010–2012). Exposure: Pra risk model (original and modified) calculated for baseline year where ≥0.5 denoted high risk (patient questionnaire, GP medical record review) of future emergency admission.Primary outcomeEmergency admission over 1 year (GP medical record review). Statistical analysis: descriptive statistics, model discrimination (c-statistic) and calibration (Hosmer-Lemeshow statistic).ResultsOf 862 patients, a total of 154 (18%) had ≥1 emergency admission(s) in the follow-up year. 63 patients (7%) were classified as high risk by the original Pra and of these 26 (41%) were admitted. The modified Pra classified 391 (45%) patients as high risk and 103 (26%) were subsequently admitted. Both models demonstrated only poor discrimination (original Pra: c-statistic 0.65 (95% CI 0.61 to 0.70); modified Pra: c-statistic 0.67 (95% CI 0.62 to 0.72)). When categorised according to risk-category model, specificity was highest for the original Pra at cut-point of ≥0.5 denoting high risk (95%), and for the modified Pra at cut-point of ≥0.7 (95%). Both models overestimated the number of admissions across all risk strata.ConclusionsWhile the original Pra model demonstrated poor discrimination, model specificity was high and a small number of patients identified as high risk. Future validation studies should examine higher cut-points denoting high risk for the modified Pra, which has practical advantages in terms of application in GP. The original Pra tool may have a role in identifying higher-risk community-dwelling older people for inclusion in future trials aiming to reduce emergency admissions.

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“…Boult et al 5 encontraram proporção de 7,2% de idosos americanos de alto risco, não institucionalizados, beneficiários do programa Medicare, com idade maior ou igual a setenta anos. Wagner et al 12 , em estudo com idosos de 65 anos ou mais, não institucionalizados, realizado em três cidades europeias -Hamburgo (Alemanha), Londres (Reino Unido) e Solothurn (Suíça), encontraram 7%, 4% e 5% de idosos de alto risco, respectivamente. No Brasil, Guerra & Ramos-Cerqueira 18 encontraram 6,2% de idosos de risco alto em uma amostra de 305 indivíduos com 65 anos ou mais, usuários de um Centro de Saúde Escola em Botucatu, São Paulo.…”

Section: Discussionunclassified

“…Ele é simples e de rápida aplicação, e a sua validade foi determinada em populações com diferentes características 6,7,8,9,10,11,12 . Contudo, no Brasil, ainda é necessário que estudos de validação sejam desenvolvidos antes de considerá-lo adequado para rastreamento de idosos frágeis em nossas instituições.…”

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Rede FIBRA-RJ: fragilidade e risco de hospitalização em idosos da cidade do Rio de Janeiro, Brasil

Perez

Lourenço

2013

Cad. Saúde Pública

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O objetivo do estudo foi determinar o perfil de risco e fatores associados à fragilidade em idosos da comunidade. A população-fonte constituiu-se de indivíduos com 65 anos ou mais, residentes nos bairros da zona norte da cidade do Rio de Janeiro, Brasil, e clientes de uma operadora de saúde. O estudo foi transversal, na linha de base de uma coorte, com amostra estratificada por sexo e idade, composta por 764 indivíduos. Para a estratificação de risco, utilizou-se o instrumento de rastreio probabilidade de internações repetidas (PIR). A análise de regressão logística foi realizada para estudar a associação entre a PIR e um conjunto de variáveis sociodemográficas, de estado de saúde, funcionais e cognitivas, após a análise bivariada. Encontraram-se 6,7% de idosos com alto risco de internação. Associaram-se ao risco de internação câncer, quedas, doença pulmonar obstrutiva crônica e medicamentos usados, bem como as seguintes condições: receber visita de profissional da saúde, ter estado acamado no domicílio, morar só e praticar as atividades de vida diária. O instrumento parece ser útil na estratificação de risco dos idosos.

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Predicting the Risk of Hospital Admission in Older Persons—Validation of a Brief Self‐Administered Questionnaire in Three European Countries

Cited by 45 publications

References 26 publications

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

Patient-Reported Geriatric Symptoms as Risk Factors for Hospitalization and Emergency Department Visits

External validation of the Probability of repeated admission (Pra) risk prediction tool in older community-dwelling people attending general practice: a prospective cohort study

Rede FIBRA-RJ: fragilidade e risco de hospitalização em idosos da cidade do Rio de Janeiro, Brasil

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