Risk Factors for Hospitalization Among Community-Dwelling Primary Care Older Patients

Development and Validation of a Predictive Model

Bibliographic Data

ID9097955
AuthorsSharon K Inouye (0000-0002-3663-2937, Harvard University, corresponding author), Ying Zhang (0000-0001-6214-2440, Hebrew SeniorLife), Richard N Jones (0000-0002-1049-218X, Hebrew SeniorLife, corresponding author), Peilin Shi (Hebrew SeniorLife), L Adrienne Cupples (0000-0003-0273-7965, Boston University), Harold N Calderon, Edward R Marcantonio (0000-0002-2911-4250, Hebrew SeniorLife, corresponding author)
Year2008
Volume46
Issue7
Pages726-731
Publication date2008-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181649426
PMID18580392
PMCIDPMC2516963
OpenAlexW2055873810
LanguageEN
Citations received6
References cited42

BACKGROUND: Unplanned hospitalization often represents a costly and hazardous event for the older population. OBJECTIVES: To develop and validate a predictive model for unplanned medical hospitalization from administrative data. RESEARCH DESIGN: Model development and validation. SUBJECTS: A total of 3919 patients aged > or =70 years who were followed for at least 1 year in primary care clinics of an academic medical center. MEASURES: Risk factor data and the primary outcome of unplanned medical hospitalization were obtained from administrative data. RESULTS: Of 1932 patients in the development cohort, 299 (15%) were hospitalized during 1 year follow up. Five independent risk factors were identified in the preceding year: Deyo-Charlson comorbidity score > or =2 [adjusted relative risk (RR) = 1.8; 95% confidence interval (CI): 1.4-2.2], any prior hospitalization (RR = 1.8; 95% CI: 1.5-2.3), 6 or more primary care visits (RR = 1.6; 95% CI: 1.3-2.0), age > or =85 years (RR = 1.4; 95% CI: 1.1-1.7), and unmarried status (RR = 1.4; 95% CI: 1.1-1.7). A risk stratification system was created by adding 1 point for each factor present. Rates of hospitalization for the low- (0 factor), intermediate- (1-2 factors), and high-risk (> or =3 factors) groups were 5%, 15%, and 34% (P < 0.0001). The corresponding rates in the validation cohort, where 328/1987 (17%) were hospitalized, were 6%, 16%, and 36% (P < 0.0001). CONCLUSIONS: A predictive model based on administrative data has been successfully validated for prediction of unplanned hospitalization. This model will identify patients at high risk for hospitalization who may be candidates for preventive interventions

Cohort · Cohort study · Comorbidity · Confidence interval · Environmental health · Family medicine · Population · Primary care · Relative risk · Risk factor · Chronic Disease Management Strategies · Emergency Medicine · Frailty in Older Adults · Internal Medicine · Medicine · Primary Care and Health Outcomes