The Higher Care At Discharge Index (HCDI): Identifying older patients at risk of requiring a higher level of care at discharge

Prabha Lakhan*, Mark Jones, Andrew Wilson, Leonard C. Gray

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

5 Citations (Scopus)

Abstract

A screening index, administered at admission, can be useful in identifying older hospitalised patients at risk of requiring a higher level care at discharge. The objective of this study was to describe the development of a risk stratification index for allocating patients into lower and higher risk of requiring higher level care at discharge. A prospective cohort study of general medical patients, aged ≥70 years admitted to three metropolitan acute care hospitals in Brisbane, Australia was conducted. Derivation cohort (. n=. 360) was used to: identify significant predictive factors associated with discharge to a higher level care; and develop a screening index to stratify patients into lower and higher risk. Predictive performance of the index was examined in the validation cohort (. n=. 142). Five independent factors associated with requiring higher level care (identified using stepwise logistic regression analysis) were used to develop the HCDI: no support person to assist with living in the community; received assistance with finances; received assistance with hygiene; short term memory problems; hospitalised in 90 days prior to current hospital admission. Sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of the dichotomised risk scores of the HCDI were: 76.3%; 73.3%; 36.0%; and 94.0% respectively; correctly classified 73.8%. In the validation cohort, sensitivity was 81.8%; specificity 68.7%; PPV 18.0%; NPV 97.8%, correctly classified 69.7%. Requirement for a higher level care at discharge has important consequences for health service delivery. The HCDI can be used to identify patients at higher risk.

Original languageEnglish
Pages (from-to)184-191
Number of pages8
JournalArchives of Gerontology and Geriatrics
Volume57
Issue number2
DOIs
Publication statusPublished - Sept 2013

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