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

Abstract

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.

Keywords: geriatric medicine; health & safety; quality in health care; risk management.