Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study
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, perfor...
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BioMed Central
2021
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Online Access: | http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515741/ http://www.ncbi.nlm.nih.gov/pubmed/34649526 https://doi.org/10.1186/s12877-021-02521-2 |
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Research 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. Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
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Research |
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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. SUPPLEMENTARY INFORMATION: The online version ... |
format |
Text |
author |
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. |
author_facet |
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. |
author_sort |
Klunder, Jet H. |
title |
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
title_short |
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
title_full |
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
title_fullStr |
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
title_full_unstemmed |
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
title_sort |
predicting unplanned hospital visits in older home care recipients: a cross-country external validation study |
publisher |
BioMed Central |
publishDate |
2021 |
url |
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515741/ http://www.ncbi.nlm.nih.gov/pubmed/34649526 https://doi.org/10.1186/s12877-021-02521-2 |
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Iceland |
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Iceland |
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BMC Geriatr |
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515741/ http://www.ncbi.nlm.nih.gov/pubmed/34649526 http://dx.doi.org/10.1186/s12877-021-02521-2 |
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© The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
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op_doi |
https://doi.org/10.1186/s12877-021-02521-2 |
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BMC Geriatrics |
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21 |
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1 |
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ftpubmed:oai:pubmedcentral.nih.gov:8515741 2023-05-15T16:48:45+02:00 Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study 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. 2021-10-14 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515741/ http://www.ncbi.nlm.nih.gov/pubmed/34649526 https://doi.org/10.1186/s12877-021-02521-2 en eng BioMed Central http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515741/ http://www.ncbi.nlm.nih.gov/pubmed/34649526 http://dx.doi.org/10.1186/s12877-021-02521-2 © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. CC0 PDM CC-BY BMC Geriatr Research Text 2021 ftpubmed https://doi.org/10.1186/s12877-021-02521-2 2021-10-24T00:32:44Z 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. SUPPLEMENTARY INFORMATION: The online version ... Text Iceland PubMed Central (PMC) BMC Geriatrics 21 1 |