Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool
Objective Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.Design Retrospective cohort study.Setting The risk score was developed using data from a hospita...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/8/e070559.full |
| _version_ | 1797755219430342656 |
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| author | Patrik Midlöv Åsa Bondesson Ulf Jakobsson Maria Glans Thomas Gerardus Hendrik Kempen Annika Kragh Ekstam |
| author_facet | Patrik Midlöv Åsa Bondesson Ulf Jakobsson Maria Glans Thomas Gerardus Hendrik Kempen Annika Kragh Ekstam |
| author_sort | Patrik Midlöv |
| collection | DOAJ |
| description | Objective Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.Design Retrospective cohort study.Setting The risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.Participants The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017–2018.Measures The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden’s index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.Results The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.Conclusion The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities. |
| first_indexed | 2024-03-12T17:43:42Z |
| format | Article |
| id | doaj.art-7315ba77623f47cc8f5d96bab1e0d19c |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-12T17:43:42Z |
| publishDate | 2023-08-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-7315ba77623f47cc8f5d96bab1e0d19c2023-08-03T21:30:07ZengBMJ Publishing GroupBMJ Open2044-60552023-08-0113810.1136/bmjopen-2022-070559Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment toolPatrik Midlöv0Åsa Bondesson1Ulf Jakobsson2Maria Glans3Thomas Gerardus Hendrik Kempen4Annika Kragh Ekstam5Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, SwedenDepartment of Medicines Management and Informatics, Skåne County Council, Kristianstad, Sweden1 Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Malmö, SwedenCenter for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, SwedenDepartment of Pharmacy, Uppsala University, Uppsala, SwedenKristianstad-Hässleholm Hospitals, Department of Orthopaedics, Region Skåne, Kristianstad, SwedenObjective Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.Design Retrospective cohort study.Setting The risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.Participants The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017–2018.Measures The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden’s index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.Results The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.Conclusion The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.https://bmjopen.bmj.com/content/13/8/e070559.full |
| spellingShingle | Patrik Midlöv Åsa Bondesson Ulf Jakobsson Maria Glans Thomas Gerardus Hendrik Kempen Annika Kragh Ekstam Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool BMJ Open |
| title | Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool |
| title_full | Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool |
| title_fullStr | Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool |
| title_full_unstemmed | Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool |
| title_short | Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool |
| title_sort | identifying older adults at increased risk of medication related readmission to hospital within 30 days of discharge development and validation of a risk assessment tool |
| url | https://bmjopen.bmj.com/content/13/8/e070559.full |
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