The Higher Care At Discharge Index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge

Lakhan, Prabha, Jones, Mark, Wilson, Andrew and Gray, Leonard C. (2013) The Higher Care At Discharge Index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge. Archives of Gerontology and Geriatrics, 57 2: 184-191. doi:10.1016/j.archger.2013.04.003


Author Lakhan, Prabha
Jones, Mark
Wilson, Andrew
Gray, Leonard C.
Title The Higher Care At Discharge Index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge
Journal name Archives of Gerontology and Geriatrics   Check publisher's open access policy
ISSN 0167-4943
1872-6976
Publication date 2013-09-01
Year available 2013
Sub-type Article (original research)
DOI 10.1016/j.archger.2013.04.003
Volume 57
Issue 2
Start page 184
End page 191
Total pages 8
Place of publication Shannon, Co. Clare, Ireland
Publisher Elsevier
Collection year 2014
Language eng
Formatted abstract
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.
Keyword Hospital discharge
Risk factors
Higher care
Nursing home admission
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
School of Public Health Publications
School of Medicine Publications
 
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