- •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.
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.
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- Risk prediction models for hospital readmission: a systematic review.JAMA. 2011; 306: 1688-1698
- Outcomes after unplanned admission to hospital in older people: ill-defined conditions as potential indicators of the frailty trajectory.J. Am. Geriatr. Soc. 2012; 60: 2104-2109
- Why do older people with multi-morbidity experience unplanned hospital admissions from the community: a root cause analysis.BMC Health Serv. Res. 2015; 15: 525
- Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review.Med. Care. 2014; 52: 751-765
- Transitional care management in the outpatient setting.BMJ Qual. Improv. Rep. 2017; 6
- Risk factors for hospital readmissions in elderly patients: a systematic review.QJM. 2011; 104: 639-651
- Screening for elderly patients admitted to the emergency department requiring specialized geriatric care.J. Emerg. Med. 2013; 45: 739-745
- The ageing society and emergency hospital admissions.Health Policy. 2017; 121: 923-928
- Patient-, provider-, and system-level barriers to heart failure care.J. Cardiovasc. Nurs. 2009; 24: 290-298
- Older adults in the emergency department: a systematic review of patterns of use, adverse outcomes, and effectiveness of interventions.Ann. Emerg. Med. 2002; 39: 238-247
- A systematic review of interventions to improve outcomes for elders discharged from the emergency department.Acad. Emerg. Med. 2005; 12: 978-986
- Who is at risk of long hospital stay among patients admitted to geriatric acute care unit? Results from a prospective cohort study.J. Nutr. Health Aging. 2013; 17: 695-699
- Mobile geriatric team and length of hospital stay among older inpatients: a case-control pilot study.J. Am. Geriatr. Soc. 2012; 60: 1593-1594
- Risk of in-hospital mortality following emergency department admission: results from the geriatric EDEN cohort study.J. Nutr. Health Aging. 2014; 18: 83-86
- Screening for older emergency department inpatients at risk of prolonged hospital stay: the brief geriatric assessment tool.PLoS One. 2014; 9e110135
- Predicting prolonged length of hospital stay in older emergency department users: use of a novel analysis method, the Artificial Neural Network.Eur. J. Intern. Med. 2015; 26: 478-482
- Risk of unplanned emergency department readmission after an acute-care hospital discharge among geriatric inpatients: results from the geriatric EDEN cohort study.J. Nutr. Health Aging. 2016; 20: 210-217
- Predicting long-term mortality of older adults after acute care discharge: results from the geriatric emergency department elderly population cohort study.J. Am. Geriatr. Soc. 2016; 64: 215-216
- Studies of illness in the aged. The index of adl: a standardized measure of biological and psychosocial function.Jama. 1963; 21: 914-919
- Restriction in complex activities of daily living in MCI: impact on outcome.Neurology. 2016; 67: 461-466
- The identification of frailty: a systematic literature review.J. Am. Geriatr. Soc. 2011; 59: 2129-2138
- Promoting access to innovation for frail old persons. IAGG (International Association of Gerontology and Geriatrics), WHO (World Health Organization) and SFGG (Société Française de Gériatrie et de Gérontologie) Workshop--Athens January 20-21, 2012 Tool (GFST).J. Nutr. Health Aging. 2013; 17: 688-693
- FRAILTY: A Report from the 3(rd) Joint Workshop of IAGG/WHO/SFGG, Athens, January 2012.Can. Geriatr. J. 2013; 15: 31-36
- Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.Lancet. 2012; 380: 37-43
- The effectiveness of a comprehensive geriatric assessment intervention program for frailty in community-dwelling older people: a randomized, controlled trial.Arch. Gerontol. Geriatr. 2010; 50: S39-42
- The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis.J. Am. Geriatr. Soc. 2010; 58: 83-92
- Number of drug classes taken per day may be used to assess morbidity burden in older inpatients: a pilot cross-sectional study.J. Am. Geriatr. Soc. 2013; 61: 1224-1225
- Gender differences in processing information for making self-assessments of health.Psychosom. Med. 2000; 62 (See also: Shields, Margot and Sanin Shooshtari. 2001. "Determinants of self-perceived health." Health Reports. 200. Vol. 13, no. 1, December. Statistics Canada Catalogue no. 82-003, pp. 35-52): 354-364
- Gender differences in health perceptions and their predictors.Soc. Sci. Med. 1993; 36: 419-427
- Differences in drug use between men and women: an Italian cross sectional study.BMC Womens Health. 2017; 17: 73
Published online: January 03, 2019
Accepted: January 3, 2019
Received in revised form: December 7, 2018
Received: August 31, 2018
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