Screening for vulnerable older people: Is the Probability of Repeated Admission scale an accurate tool?

Abstract

Aim To evaluate the Probability of Repeated Admission (Pra) scale performance in predicting healthcare utilization and death in a community sample of Rio de Janeiro city, Brazil. Methods This was a prospective longitudinal study. The sample was composed of community‐dwelling older people who participated in the research network Frailty in Brazilian Older People Study, Rio de Janeiro section. It analyzed data from the baseline and the follow up. At the baseline, 764 older adults were stratified by the Pra, and, 3 years later, data on health services utilization and survival status were collected. The Pra accuracy, obtained by the area under the curve, the sensitivity and the specificity to predict hospitalization in 3 years; visits to the emergency department; and death were determined. Cox regression estimated the survival curves, according to the risk strata. Results The accuracy, the sensitivity and the specificity of Pra were 62% (95% CI 57–68%), 8.8% and 95.4% for hospitalization in 3 years; 59% (95% CI 53–64%), 8.3% and 94.8% for emergency room visits; 66% (95% CI 59–74%) and 68% (95% CI 63–73%), 15.0% and 96.0% for death. Survival curves showed that high‐risk individuals were more likely to die compared with the low‐risk individuals, adjusted to covariables (P < 0.001). Conclusions The Pra presented low accuracy, low sensitivity and high specificity for all outcomes observed, indicating a poor performance to screen vulnerable older adults in Brazil. Therefore, this tool should not be used alone, as a case‐finding instrument. Geriatr Gerontol Int 2020; 20: 360–365.

Exploration of risk factors for high‐risk adverse events in elderly patients after discharge and comparison of discharge planning screening tools

“…P ra ≥ 0.5 indicates a high-risk of readmission of an elderly patient (Pacala et al, 1995). The accuracy and specificity of P ra were 62%-70% and 95%-96% for readmission and mortality in community-dwelling older adults (Perez et al, 2020;Wallace et al, 2013). The parts of the LACE index are as follows: (1) a length of stay (LOS) of less than 1 day is 0 points, LOS of 1 day is 1 point, LOS of 2 days is 2 points, LOS of 3 days is 3 points, LOS of 4-6 days is 4 points, LOS of 7-13 days is 5 points, and LOS of ≥14 days is 7 points; (2) acuity of the admission is 0 points for "no" and 3 points for "yes"; (3) comorbidities of the patient, as measured with the Charlson Comorbidity Index (CCI) score with CCI = 1 is 1 point, CCI = 2 is 2 points, CCI = 3 is 3 points, and CCI of ≥4 is 5 points; and (4) emergency department (ER) use, measured as the number of visits in 6 months before admission with ER = 1 is 1…”