Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool

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Glans, MariaLund University,Lunds universitet,Allmänmedicin och samhällsmedicin,Forskargrupper vid Lunds universitet,Family Medicine and Community Medicine,Lund University Research Groups,Center for Primary Health Care Research,Hässleholm-Kristianstad-Ystad Hospitals (author)

Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge : development and validation of a risk assessment tool

Article/chapterEnglish2023

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BMJ Publishing Group Ltd,2023
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LIBRIS-ID:oai:DiVA.org:uu-510718
https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-510718URI
https://doi.org/10.1136/bmjopen-2022-070559DOI
https://lup.lub.lu.se/record/529e69bc-b2c6-4b35-ab94-0451ae881bf3URI

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Language:English
Summary in:English

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Objective: Developing and validating a risk assessment tool aiming to identify older adults (& GE;65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge.Design: Retrospective cohort study. SettingThe risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden.Participants: The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017-2018.Measures: The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden's index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation.Results: The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort.Conclusion: The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.

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Kempen, ThomasUppsala University,Uppsala universitet,Institutionen för farmaci,Univ Utrecht, Utrecht Inst Pharmaceut Sci, Div Pharmacoepidemiol & Clin Pharmacol, Utrecht, Netherlands.,Utrecht University(Swepub:uu)thoke244 (author)
Jakobsson, UlfLund University,Lunds universitet,Allmänmedicin och klinisk epidemiologi,Forskargrupper vid Lunds universitet,Family Medicine and Clinical Epidemiology,Lund University Research Groups,Center for Primary Health Care Research(Swepub:lu)cvv-uja (author)
Kragh Ekstam, AnnikaKristianstad Hassleholm Hosp, Dept Orthopaed, Reg Skane, Kristianstad, Sweden.,Hässleholm-Kristianstad-Ystad Hospitals(Swepub:lu)med-akg (author)
Bondesson, ÅsaLund University,Lunds universitet,Allmänmedicin och samhällsmedicin,Forskargrupper vid Lunds universitet,Family Medicine and Community Medicine,Lund University Research Groups,Center for Primary Health Care Research,Region Skåne(Swepub:lu)klin-abo (author)
Midlöv, PatrikLund University,Lunds universitet,Allmänmedicin och samhällsmedicin,Forskargrupper vid Lunds universitet,Family Medicine and Community Medicine,Lund University Research Groups,Center for Primary Health Care Research(Swepub:lu)klin-pmi (author)
Allmänmedicin och samhällsmedicinForskargrupper vid Lunds universitet (creator_code:org_t)

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By the author/editor: Glans, Maria; Kempen, Thomas; Jakobsson, Ulf; Kragh Ekstam, An ...; Bondesson, Åsa; Midlöv, Patrik

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Geriatrics

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