|Title||The Higher Care At Discharge Index (HCDI): identifying older patients at risk of requiring a higher level of care at discharge|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||Lakhan P., Jones M., Wilson A., Gray L.C|
|Journal||Arch Gerontol Geriatr|
|ISBN Number||1872-6976 (Electronic)<br/>0167-4943 (Linking)|
|Keywords||Age Factors, Aged, Aged, 80 and over, Female, Geriatric Assessment/methods, Health Services for the Aged/*statistics & numerical data, Health Services Needs and Demand/statistics & numerical data, Humans, Male, Patient Discharge/*statistics & numerical data, Prospective Studies, Reproducibility of Results, Risk Assessment/methods, Risk Factors|
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.