Sager M A, Rudberg M A, Jalaluddin M, Franke T, Inouye S K, Landefeld C S, Siebens H, Winograd C H
University of Wisconsin-Madison, 53706 USA.
J Am Geriatr Soc. 1996 Mar;44(3):251-7. doi: 10.1111/j.1532-5415.1996.tb00910.x.
To develop and validate an instrument for stratifying older patients at the time of hospital admission according to their risk of developing new disabilities in activities of daily living (ADL) following acute medical illness and hospitalization.
Multi-center prospective cohort study.
Four university and two private non-federal acute care hospitals.
The development cohort consists of 448 patients and the validation cohort consists of 379 patients who were aged 70 and older and who were hospitalized for acute medical illness between 1989 and 1992.
All patients were evaluated on hospital admission to identify baseline demographic and functional characteristics and were then assessed at discharge and 3 months after discharge to determine decline in ADL functioning.
Logistic regression analysis identified three patient characteristics that were independent predictors of functional decline in the development cohort: increasing age, lower admission Mini-Mental Status Exam scores, and lower preadmission IADL function. A scoring system was developed for each predictor variable and patients were assigned to low, intermediate, and high risk categories. The rates of ADL decline at discharge for the low, intermediate, and high risk categories were 17%, 28%, and 56% in the development cohort and 19%, 31%, and 55% in the validation cohort, respectively. Patients in the low risk category were significantly more likely to recover ADL function and to avoid nursing home placement during the 3 months after discharge.
Hospital Admission Risk Profile (HARP) is a simple instrument that can be used to identify patients at risk of functional decline following hospitalization. HARP can be used to identify patients who might benefit from comprehensive discharge planning, specialized geriatric care, and experimental interventions designed to prevent/reduce the development of disability in hospitalized older populations.
开发并验证一种工具，用于在老年患者入院时，根据其急性内科疾病和住院后日常生活活动（ADL）出现新残疾的风险进行分层。
多中心前瞻性队列研究。
四家大学附属医院和两家私立非联邦急症医院。
开发队列包括448例患者，验证队列包括379例年龄在70岁及以上、于1989年至1992年间因急性内科疾病住院的患者。
所有患者在入院时接受评估以确定基线人口统计学和功能特征，然后在出院时及出院后3个月进行评估，以确定ADL功能的下降情况。
逻辑回归分析确定了开发队列中功能下降的三个独立预测因素：年龄增加、入院时简易精神状态检查得分较低以及入院前工具性日常生活活动（IADL）功能较低。为每个预测变量制定了评分系统，并将患者分为低、中、高风险类别。在开发队列中，低、中、高风险类别的患者出院时ADL下降率分别为17%、28%和56%，在验证队列中分别为19%、31%和55%。低风险类别的患者在出院后3个月内恢复ADL功能并避免入住养老院的可能性显著更高。
医院入院风险概况（HARP）是一种简单的工具，可用于识别住院后有功能下降风险的患者。HARP可用于识别可能从综合出院计划、专门的老年护理以及旨在预防/减少住院老年人群残疾发生的实验性干预措施中获益的患者。
