Centre for Research in Geriatric Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Ipswich Rd., Woolloongabba, Brisbane 4102, Australia.
Arch Gerontol Geriatr. 2013 Sep-Oct;57(2):184-91. doi: 10.1016/j.archger.2013.04.003. Epub 2013 May 10.
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.
一种入院时进行的筛选指数可用于识别有较高风险在出院时需要更高水平护理的老年住院患者。本研究的目的是描述一种风险分层指数的制定，以将患者分配到较低和较高风险需要在出院时接受更高水平护理的风险类别。本前瞻性队列研究纳入了澳大利亚布里斯班三家大都市急性护理医院≥70 岁的综合医学患者。在推导队列（n=360）中：确定与出院后接受更高水平护理相关的显著预测因素；并开发一种筛选指数，将患者分层为低风险和高风险。在验证队列（n=142）中检验该指数的预测性能。使用逐步逻辑回归分析确定与需要更高水平护理相关的五个独立因素（识别）用于开发 HCDI：没有帮助在社区生活的支持人员；需要经济援助；需要卫生援助；短期记忆问题；在当前入院前 90 天内住院。HCDI 风险评分的二分法的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为：76.3%；73.3%；36.0%和 94.0%；正确分类 73.8%。在验证队列中，敏感性为 81.8%；特异性为 68.7%；PPV 为 18.0%；NPV 为 97.8%，正确分类为 69.7%。出院时需要更高水平的护理对医疗服务的提供有重要影响。HCDI 可用于识别高风险患者。
