外部验证急诊就诊指标和脆弱性（DIVERT）量表：回顾性队列研究。

External validation of the detection of indicators and vulnerabilities for emergency room trips (DIVERT) scale: a retrospective cohort study.

机构信息

Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario, L8S 4K1, Canada.

Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catherines, Ontario, L2S 3A1, Canada.

出版信息

BMC Geriatr. 2020 Oct 20;20(1):413. doi: 10.1186/s12877-020-01816-0.

DOI:10.1186/s12877-020-01816-0

PMID:33081709

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7576700/

Abstract

BACKGROUND

The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients.

METHODS

We conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories between April 1, 2011 and September 30, 2014. The DIVERT scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was ED visitation within 6 months of a RAI-HC assessment.

RESULTS

The cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (< 1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC = 0.617-0.647), two or more ED visits (AUC = 0.628-0.634) and hospital admission (AUC = 0.617-0.664).

CONCLUSIONS

The findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.

摘要

背景

用于识别和评估家庭护理客户去急诊室就诊的指标和脆弱性(DIVERT)量表是为了对急诊科(ED)使用风险进行分类和评估而开发的。本研究的目的是在家庭护理客户的二级人群中对 DIVERT 量表进行外部验证。

方法

我们进行了一项回顾性队列研究，将家庭护理报告系统和国家门诊护理报告系统的数据进行了关联。数据收集对象为接受 RAI 家庭护理(RAI-HC)评估的老年长期家庭护理客户。数据收集对象来自加拿大安大略省和艾伯塔省以及马尼托巴省温尼伯市和育空地区白马市，时间为 2011 年 4 月 1 日至 2014 年 9 月 30 日。DIVERT 量表最初是通过使用多国临床小组提供的递归分区从 RAI-HC 项目中得出的。该量表目前在加拿大各省与 RAI-HC 一起实施。本研究的主要结局是 RAI-HC 评估后 6 个月内的 ED 就诊情况。

结果

该队列包含 1,001,133 名家庭护理客户。绝大多数病例在安大略省接受服务(88%)，其次是艾伯塔省(8%)、温尼伯市(4%)和白马市(<1%)。在四个队列中，在 6 个月的随访期间，DIVERT 量表对所有结局的判别能力与原始验证工作相似：ED 就诊(AUC=0.617-0.647)、两次或以上 ED 就诊(AUC=0.628-0.634)和住院(AUC=0.617-0.664)。