Use of an electronic administrative database to identify older community dwelling adults at high-risk for hospitalization or emergency department visits: The elders risk assessment index

Abstract

BackgroundThe prevention of recurrent hospitalizations in the frail elderly requires the implementation of high-intensity interventions such as case management. In order to be practically and financially sustainable, these programs require a method of identifying those patients most at risk for hospitalization, and therefore most likely to benefit from an intervention. The goal of this study is to demonstrate the use of an electronic medical record to create an administrative index which is able to risk-stratify this heterogeneous population.MethodsWe conducted a retrospective cohort study at a single tertiary care facility in Rochester, Minnesota. Patients included all 12,650 community-dwelling adults age 60 and older assigned to a primary care internal medicine provider on January 1, 2005. Patient risk factors over the previous two years, including demographic characteristics, comorbid diseases, and hospitalizations, were evaluated for significance in a logistic regression model. The primary outcome was the total number of emergency room visits and hospitalizations in the subsequent two years. Risk factors were assigned a score based on their regression coefficient estimate and a total risk score created. This score was evaluated for sensitivity and specificity.ResultsThe final model had an AUC of 0.678 for the primary outcome. Patients in the highest 10% of the risk group had a relative risk of 9.5 for either hospitalization or emergency room visits, and a relative risk of 13.3 for hospitalization in the subsequent two year period.ConclusionsIt is possible to create a screening tool which identifies an elderly population at high risk for hospital and emergency room admission using clinical and administrative data readily available within an electronic medical record.

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

“…The ERA index is a risk stratification instrument that uses several risk factorsage, marital status, hospitalization in the past 2 years, and history of diabetes, heart disease, stroke, emphysema, cancer (excluding nonmelanomatous skin cancer), and dementia-to calculate a total score for each patient. 12 With a score range of Ϫ1 to 32, the ERA index was found to predict the number of hospitalizations and emergency department visits in the subsequent 2 years in this cohort of patients.…”

“…To answer this question, we proposed using the Elders Risk Assessment (ERA) index, which is a universal scoring system that predicts hospitalization and emergency department visits in adults older than 60 years of age in a primary care practice. 12 The ERA index has been implemented in the daily practice within the Primary Care Internal Medicine (PCIM) division at Mayo Clinic in Rochester, Minnesota. At each patient-physician encounter, an ERA score is automatically computed using a software program without any intervention from the physician.…”

“…At each patient-physician encounter, an ERA score is automatically computed using a software program without any intervention from the physician. 12 We used a retrospective cohort study, stratified by the ERA scores, and examined incident hip fractures. We hypothesized that a higher ERA score indicates a higher risk for sustaining hip fracture.…”

A Patient Navigator Intervention to Reduce Hospital Readmissions among High-Risk Safety-Net Patients: A Randomized Controlled Trial

“…We assess the effects of this intervention in two distinct patient populations-those over and under age 60-groups whose distinctive distribution of medical and psychiatric comorbidities [26][27][28] and different networks of social support 29,30 shape their post-discharge needs and potentially their response to the PN intervention.…”

Older adults who persistently present to the emergency department with severe, non-severe, and indeterminate episode patterns

“…More recent efforts have developed predictive models in which age and disease history were identified as risk factors for increased ED use, and suggested clinical and administrative claims data could be useful in managing ED use among older individuals [17,18]. …”