Identifying older adults at increased risk of medication-related hospital readmission

• IntroductionPrevious studies show that approximately 40% of hospital readmissions in older adults are medication-related and that about 70% of these could be prevented. A risk assessment tool aiming to identify older adults at increased risk of medication-related readmission could help maximize the impact of implemented preventive measures and save healthcare resources. In this study we made further adjustments to our previously developed risk assessment tool (the HOME Score) aiming to increase its predictive ability as well as its clinical usefulness.MethodsThe risk assessment tool was developed through comparison of possibly medication-related readmissions (n=143) and a comparison group (n=360). Included variables were known at first admission and individually associated with possibly medication-related readmission. Variables were assigned points, and a risk score was calculated for all individuals. A threshold score was decided on, using Youden's index, and the area under the ROC-curve (C-index) was used to measure discrimination. Sensitivity, specificity, and positive and negative predictive values were calculated.ResultsThe developed risk assessment tool - the Hospitalisations, Own home, Medications, and diagnoses (HOMe+) Score - includes six variables assigned one point each. The area under the ROC-curve (C-index) is 0.733, sensitivity 81%, specificity 50%, positive predictive value 39%, and negative predictive value 87% at the threshold score (≥ 2 points).ConclusionsThe HOMe+ Score can help identify older adults in most need of preventive measures aiming to decrease the risk of medication-related hospital readmission. Further studies are needed to validate the HOMe+ Score in clinical care as well as investigate the benefits of implemented activities.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Geriatrik (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Geriatrics (hsv//eng)

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