Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study.

• Published in: BMC Geriatrics
• Main Authors: Klunder, Jet H, Bordonis, Veronique, Heymans, Martijn W, van der Roest, Henriëtte G, Declercq, Anja, Smit, Jan H, Garms-Homolova, Vjenka, Jónsson, Pálmi V, Finne-Soveri, Harriet, Onder, Graziano, Joling, Karlijn J, Maarsingh, Otto R, van Hout, Hein P J
• Other Authors: 1Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. [e-mail]. 2Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. 3Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. 4Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands. 5Center for Care Research & Consultancy (LUCAS) & Center for Sociological Research (CESO), KU Leuven, Leuven, Belgium. 6Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands. 7Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany. 8Department of Geriatrics, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 9Department of Wellbeing, National Institute for Health and Wellbeing, Helsinki, Finland. 10Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy. 11Department of Medicine for Older People, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
• Format: Article in Journal/Newspaper
• Language: English
• Published: BioMed Central 2022
• Subjects: Emergency department visits; Geographical validation; Home care; Risk prediction models; Unplanned hospitalizations; Sjúkrahúsvist; Aldraðir; Bráðadeildir; Áhættugreining; Aged; 80 and over; Emergency Service; Hospital; Home Care Services; Hospitals; Risk Factors; Iceland
• Online Access: http://hdl.handle.net/2336/622027; https://doi.org/10.1186/s12877-021-02521-2

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download 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 ...