The Hospital Admission Risk Profile

Graf, Carla

doi:10.1097/01.naj.0000327832.59406.26

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…Based on the original Sager HARP protocol (Figure ), the LNA used age at the time of admission, modified Folstein MMSE score, and self‐ or family‐reported IADL dependence 2 weeks before admission to calculate a HARP score for each participant . The modified Folstein MMSE omits the language items, and the IADLs evaluated included managing finances, taking medications, use of the telephone, shopping, transportation, housekeeping, and food preparation . Individuals with complete dependence in all ADL categories were included in this study but were excluded from the original HARP validation study (because people with complete ADL dependence had no potential to decline in ADL function) …”

Section: Methodsmentioning

confidence: 99%

“…13 The modified Folstein MMSE omits the language items, and the IADLs evaluated included managing finances, taking medications, use of the telephone, shopping, transportation, housekeeping, and food preparation. 13,17 Individuals with complete dependence in all ADL categories were included in this study but were excluded from the original HARP validation study (because people with complete ADL dependence had no potential to decline in ADL function). 13 Covariates Participant electronic medical record numbers were recorded in a secure database and used to query the data warehouse to obtain additional data.…”

Section: Primary Predictor: Harpmentioning

confidence: 99%

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Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults

Liu

Montgomery

Yan

et al. 2016

J American Geriatrics Society

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Objectives To evaluate whether the Hospital Admission Risk Profile (HARP) score is associated with skilled nursing or acute rehabilitation facility discharge following an acute hospitalization. Design Retrospective cohort study Setting One inpatient unit of a rural, academic medical center Participants Hospitalized patients 70 years or older from October 1, 2013 to June 1, 2014 Measurements Patient age at the time of admission, modified Folstein Mini-Mental Status Exam score, and self-reported instrumental activities of daily living two weeks prior to admission were used to calculate a HARP score. The primary predictor was HARP score and the primary outcome was discharge disposition (home, facility, or deceased). Multivariate analysis evaluated the association between HARP score and discharge disposition adjusting for age, sex, comorbidities, and length of stay. Results Four hundred twenty eight patients, admitted from home, were screened and categorized by HARP score as low (162 [37.8%]), intermediate (157 [36.7%]), or high (109 [25.5%]). Patients with high HARP scores were significantly more likely to be discharged to a facility compared to those with low HARP scores (55% vs. 20%; p<0.001). After adjustment, patients with high compared to low HARP scores were over 4 times more likely to be discharged to a facility (OR 4.58, 95% CI 2.42–8.66). Conclusion Among a population of older hospitalized adults, the HARP score (using readily available admission information) identifies patients at increased risk for skilled nursing or acute rehabilitation facility discharge. Early patient identification for potential facility discharges may allow for targeted interventions to prevent functional decline, improve informed shared decision-making about post-acute care needs, and expedite discharge planning.

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Section: Methodsmentioning

confidence: 99%

Section: Primary Predictor: Harpmentioning

confidence: 99%

Association Between Hospital Admission Risk Profile Score and Skilled Nursing or Acute Rehabilitation Facility Discharges in Hospitalized Older Adults

Liu

Montgomery

Yan

et al. 2016

J American Geriatrics Society

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“…Cognition was assessed using the standard test at our institution, the abbreviated Mini Mental State Examination (MMSE). The abbreviated MMSE was performed and scored according to customary protocol and scale (0–21) [14,15]. Cognitive impairment is defined as a score ≤14 [14].…”

Section: Methodsmentioning

confidence: 99%

“…The abbreviated MMSE was performed and scored according to customary protocol and scale (0–21) [14,15]. Cognitive impairment is defined as a score ≤14 [14]. Cognitive and functional capacity scores were recorded and compared against age quartiles to determine if there was any difference in scores among the age groups.…”

Section: Methodsmentioning

confidence: 99%

Preoperative impairment is associated with a higher postdischarge level of care

Ehlenbach

Tevis

Kennedy

et al. 2015

Journal of Surgical Research

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Background Although preoperative risk factors have been shown to lead to postdischarge institutionalization, an association between preoperative risk factors, preoperative level of required care, and discharge to higher levels of care has not previously been demonstrated. Materials and methods Using an institutional American College of Surgeons National Surgical Quality Improvement Program database, a retrospective review of elderly patients undergoing nonemergent inpatient general surgery procedures was performed with the goal of identifying preoperative risk factors that indicated the need for a higher level of care on hospital discharge. Univariate and multivariate analyses were performed on the patient population. Results Over a 4-y period, 585 patients (29%) within the database were aged ≥65 y. In this population, 12% of patients required discharge to a higher level of care compared with their preoperative origin. In patients aged ≥65 y, impaired cognition, decreased functional capacity, advanced age (≥79 y), high American Society of Anesthesiologists class, and long hospital length of stay were found in univariate analysis to be associated with postoperative discharge to a higher level of care, although all of these variables except decreased functional capacity were also associated with a higher discharge level of care in multivariate analysis. Conclusions Cognitive and functional capacity scoring can be used as simple ways to indicate discharge to a higher level of care for older adults. Preoperative counseling in high-risk older adults needs to include the likelihood for discharge to a higher level of care, so that a possible referral to social work can be placed during discharge planning.

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