Boult et al identified a number of criteria that can help identify an elderly patient who is at risk for hospital readmission within a 4 year period. This can help identify elderly patients who may benefit from closer monitoring and more aggressive management. The authors are from the University of Minnesota.
Screening criteria associated with hospital admission:
(1) male gender
(2) older age (>= 75 years)
(3) self-rated health given as poor (fair self-rated health also carries a higher risk)
(4) having an informal caregiver (in theory reflecting worse health since a caregiver is needed)
(5) having coronary artery disease
(6) having been admitted to the hospital within the past year
(7) having >= 7 doctor visits within the past year
(8) having diabetes mellitus (within the past year)
|
Parameter
|
Regression Coefficient
|
|
male gender
|
0.257
|
|
very good health
|
0.327
|
|
good health
|
0.340
|
|
fair health
|
0.552
|
|
poor health
|
0.770
|
|
coronary artery disease
|
0.390
|
|
diabetes
|
0.319
|
|
hospital admission in past year
|
0.545
|
|
>= 7 doctor visits
|
0.318
|
|
no informal caregiver
|
-0.738
|
|
age 75-79 years
|
0.255
|
|
age 80-84 years
|
0.327
|
|
age >= 85 years
|
0.559
|
see Table 2, page 814
X =
= SUM(points for regression coefficients times 0 or 1 for present or absent) - 1.802
probability of repeated admission within 4 years =
= EXP(X) / (1 + EXP(X))
total number of risk factors =
= SUM(number of risk factors present)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 8
• A patient was classified as high risk if the probability of repeated admission was >= 50%.
• This corresponds to a value of X >= 0, which corresponds to a sum of regression coefficients >= 1.8.
• The maximum probability is 80% if all 8 risk factors (including age >= 85, poor health) are present.
• The more risk factors that are present the greater the risk of being readmitted to the hospital.
An approach that might simplify this is as follows:
|
Parameter
|
Points
|
|
male gender
|
1
|
|
very good health
|
1
|
|
good health
|
1
|
|
fair health
|
2
|
|
poor health
|
3
|
|
coronary artery disease
|
1
|
|
diabetes
|
1
|
|
hospital admission in past year
|
2
|
|
>= 7 doctor visits
|
1
|
|
no informal caregiver
|
-3
|
|
age 75-79 years
|
1
|
|
age 80-84 years
|
1
|
|
age >= 85 years
|
2
|
with a sum of points >= 7 indicating high risk.
