A study protocol for a predictive model to assess population-based avoidable hospitalization risk: Avoidable Hospitalization Population Risk Prediction Tool (AvHPoRT)

Laura C Rosella; Mackenzie Hurst; Meghan O'Neill; Lief Pagalan; Lori Diemert; Kathy Kornas; Andy Hong; Stacey Fisher; Douglas G Manuel

doi:10.1186/s41512-024-00165-5

A study protocol for a predictive model to assess population-based avoidable hospitalization risk: Avoidable Hospitalization Population Risk Prediction Tool (AvHPoRT)

Diagn Progn Res. 2024 Feb 6;8(1):2. doi: 10.1186/s41512-024-00165-5.

Authors

Laura C Rosella^{1

2

3

4}, Mackenzie Hurst^{5

6}, Meghan O'Neill⁵, Lief Pagalan⁵, Lori Diemert⁵, Kathy Kornas⁵, Andy Hong^{7

8

9}, Stacey Fisher^{5

10}, Douglas G Manuel^{10

11

12

13

14}

Affiliations

¹ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada. laura.rosella@utoronto.ca.
² Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada. laura.rosella@utoronto.ca.
³ Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. laura.rosella@utoronto.ca.
⁴ ICES, Toronto, ON, M4N 3M5, Canada. laura.rosella@utoronto.ca.
⁵ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada.
⁶ ICES, Toronto, ON, M4N 3M5, Canada.
⁷ PEAK Urban Research Programme, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK.
⁸ Department of City & Metropolitan Planning, University of Utah, Salt Lake City, UT, USA.
⁹ The George Institute for Global Health, Newtown, NSW, Australia.
¹⁰ Ottawa Hospital Research Institute, Ottawa, Canada.
¹¹ Statistics Canada, Ottawa, Canada.
¹² Department of Family Medicine, University of Ottawa, Ottawa, Canada.
¹³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
¹⁴ Bruyère Research Institute, Ottawa, Canada.

Abstract

Introduction: Avoidable hospitalizations are considered preventable given effective and timely primary care management and are an important indicator of health system performance. The ability to predict avoidable hospitalizations at the population level represents a significant advantage for health system decision-makers that could facilitate proactive intervention for ambulatory care-sensitive conditions (ACSCs). The aim of this study is to develop and validate the Avoidable Hospitalization Population Risk Tool (AvHPoRT) that will predict the 5-year risk of first avoidable hospitalization for seven ACSCs using self-reported, routinely collected population health survey data.

Methods and analysis: The derivation cohort will consist of respondents to the first 3 cycles (2000/01, 2003/04, 2005/06) of the Canadian Community Health Survey (CCHS) who are 18-74 years of age at survey administration and a hold-out data set will be used for external validation. Outcome information on avoidable hospitalizations for 5 years following the CCHS interview will be assessed through data linkage to the Discharge Abstract Database (1999/2000-2017/2018) for an estimated sample size of 394,600. Candidate predictor variables will include demographic characteristics, socioeconomic status, self-perceived health measures, health behaviors, chronic conditions, and area-based measures. Sex-specific algorithms will be developed using Weibull accelerated failure time survival models. The model will be validated both using split set cross-validation and external temporal validation split using cycles 2000-2006 compared to 2007-2012. We will assess measures of overall predictive performance (Nagelkerke R²), calibration (calibration plots), and discrimination (Harrell's concordance statistic). Development of the model will be informed by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement.

Ethics and dissemination: This study was approved by the University of Toronto Research Ethics Board. The predictive algorithm and findings from this work will be disseminated at scientific meetings and in peer-reviewed publications.

Keywords: Ambulatory care sensitive conditions; Avoidable hospitalization; Population level; Prediction model; Study protocol; Survival analysis.

Abstract

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