Highlights
- •Unplanned hospital admissions are associated with several health adverse consequences.
- •The 6-item brief geriatric assessment (BGA) provides a priori risk stratification of hospital health adverse events.
- •The 6-item BGA has not yet been used in primary care to identify older community-dwelling patients at risk for unplanned hospital admission.
- •The a priori 6-item BGA risk stratification was significantly associated with incident unplanned hospital admissions.
Abstract
Background: The 6-item Brief Geriatric Assessment (BGA) provides a priori risk stratification of incident hospital health adverse events, but it has not been
used yet to assess the risk of unplanned hospital admission for older patients in
primary care. This study aims to examine the association between the a priori risk stratification levels of the 6-item BGA performed by general practitioners (GPs)
and incident unplanned hospital admissions in older community patients.
Methods: Based on an observational prospective cohort design, 668 participants (mean
age 84.7 ± 3.9 years; 64.7% female) were recruited by their GPs during an index primary
care visit. The 6-item BGA was completed at baseline and provided an a priori risk stratification in three levels (low, moderate, high). Incident unplanned hospital
admissions were recorded during a 6-month follow-up.
Results: The incidence of unplanned hospital admissions increased with the risk level
of the 6-item BGA stratification, the highest prevalence (35.3%) being reported with
the high-risk level (P = 0.001). The risk of unplanned hospital admission at the high-risk
level was significant (crude odds ratio (OR) = 5.48, P = 0.001 and fully adjusted
OR = 3.71, P = 0.032, crude hazard ratio (HR) = 4.20; P = 0.002 and fully adjusted
HR = 2.81; P = 0.035). The Kaplan-Meier’s distributions of incident unplanned hospital
admissions differed significantly between the three risk levels (P-value = 0.002).
Participants with a high-risk level were more frequently admitted to hospital than
those at a low-risk level (P = 0.001). Criteria performances of all risk levels were
poor, except the specificity of the high-risk level, which was 98.2%.
Conclusions: The a priori 6-item BGA risk stratification was significantly associated with incident unplanned
hospital admissions in primary care older patients. However, except for the specificity
of the high-risk level, its criteria performances were poor, suggesting that this
tool is unsuitable for screening older patients in primary care settings at risk of
unplanned hospital admission.
Keywords
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Article info
Publication history
Published online: January 03, 2019
Accepted:
January 3,
2019
Received in revised form:
December 7,
2018
Received:
August 31,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
