TY - JOUR
T1 - Predicting unplanned hospital visits in older home care recipients
T2 - a cross-country external validation study
AU - Klunder, Jet H.
AU - Bordonis, Veronique
AU - Heymans, Martijn W.
AU - van der Roest, Henriëtte G.
AU - Declercq, Anja
AU - Smit, Jan H.
AU - Garms-Homolova, Vjenka
AU - Jónsson, P. lmi V.
AU - Finne-Soveri, Harriet
AU - Onder, Graziano
AU - Joling, Karlijn J.
AU - Maarsingh, Otto R.
AU - van Hout, Hein P. J.
N1 - Funding Information:
The IBenC project was a Collaborative Research Project funded by the European Union in the Programme: FP7-HEALTH-2012-INNOVATION-1 under grant agreement no. 305912. The funding had no role in study design, data collection, analysis, and interpretation, or preparation of the manuscript.
Funding Information:
This research was supported by Stichting Preventie Vroegdiagnostiek en e-Health. The authors thank the home care clients and home care organizations for their involvement in the project.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background: Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. It is unclear whether risk scores developed in one country, perform as well in another. This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries. Methods: We used the IBenC sample (n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. Missing data were handled by multiple imputation. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)). Results: Risk score performance varied across countries. In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 [0.68–0.80] and AUC 0.74 [0.67–0.80]), respectively). In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 [0.67–0.77]) and any unplanned hospital visits (AUC 0.73 [0.67–0.77]). In other countries, AUCs did not exceed 0.70. Conclusions: Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. Unplanned hospital visits seem considerably dependent on healthcare context. Therefore, risk scores should be validated regionally before applied to practice. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores.
AB - Background: Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. It is unclear whether risk scores developed in one country, perform as well in another. This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries. Methods: We used the IBenC sample (n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. Missing data were handled by multiple imputation. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)). Results: Risk score performance varied across countries. In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 [0.68–0.80] and AUC 0.74 [0.67–0.80]), respectively). In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 [0.67–0.77]) and any unplanned hospital visits (AUC 0.73 [0.67–0.77]). In other countries, AUCs did not exceed 0.70. Conclusions: Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. Unplanned hospital visits seem considerably dependent on healthcare context. Therefore, risk scores should be validated regionally before applied to practice. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores.
KW - Emergency department visits
KW - Geographical validation
KW - Home care
KW - Risk prediction models
KW - Unplanned hospitalizations
UR - http://www.scopus.com/inward/record.url?scp=85117304309&partnerID=8YFLogxK
U2 - 10.1186/s12877-021-02521-2
DO - 10.1186/s12877-021-02521-2
M3 - Article
C2 - 34649526
SN - 1471-2318
VL - 21
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 551
ER -