Development of a Multivariable Prediction Model for Risk of Hospitalization With Pressure Injury After Entering Residential Aged Care

Tesfahun C Eshetie; Max Moldovan; Gillian E Caughey; Catherine Lang; Janet K Sluggett; Jyoti Khadka; Craig Whitehead; Maria Crotty; Megan Corlis; Renuka Visvanathan; Steve Wesselingh; Maria C Inacio

doi:10.1016/j.jamda.2022.12.009

Development of a Multivariable Prediction Model for Risk of Hospitalization With Pressure Injury After Entering Residential Aged Care

J Am Med Dir Assoc. 2023 Mar;24(3):299-306.e9. doi: 10.1016/j.jamda.2022.12.009. Epub 2023 Jan 3.

Authors

Affiliations

¹ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia. Electronic address: Tesfahun.Eshetie@sahmri.com.
² Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
³ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
⁴ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia.
⁵ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
⁶ College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.
⁷ UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia; Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.
⁸ National Health and Medical Research Council, Centre of Research Excellence Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia; Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia; Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia.
⁹ South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
¹⁰ Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia.

PMID: 36603825
DOI: 10.1016/j.jamda.2022.12.009

Abstract

Objectives: Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data.

Design: National retrospective cohort study.

Setting and participants: Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016.

Methods: PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care-related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample.

Results: Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77-3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74-2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44-2.05); and history of skin disease (sHR 1.54; 95% CI 1.45-1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72-0.75).

Conclusions and implications: Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry.

Keywords: Aged care; long-term care; nursing homes; pressure injury; risk prediction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia
Homes for the Aged
Hospitalization
Humans
Pressure Ulcer*
Retrospective Studies