Abstract
BackgroundThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients. The objective of this study was to externally validate the DIVERT scale in a secondary population of home care clients.MethodsWe conducted a retrospective cohort study, linking data from the Home Care Reporting System and the National Ambulatory Care Reporting System. Data were collected on older long-stay home care clients who received a RAI Home Care (RAI-HC) assessment. Data were collected for home care clients in the Canadian provinces of Ontario and Alberta, as well as in the cities of Winnipeg, Manitoba and Whitehorse, Yukon Territories between April 1, 2011 and September 30, 2014. The DIVERT scale was originally derived from the items of the RAI-HC through the use of recursive partitioning informed by a multinational clinical panel. This scale is currently implemented alongside the RAI-HC in provinces across Canada. The primary outcome of this study was ED visitation within 6 months of a RAI-HC assessment.ResultsThe cohort contained 1,001,133 home care clients. The vast majority of cases received services in Ontario (88%), followed by Alberta (8%), Winnipeg (4%), and Whitehorse (< 1%). Across the four cohorts, the DIVERT scale demonstrated similar discriminative ability to the original validation work for all outcomes during the six-month follow-up: ED visitation (AUC = 0.617–0.647), two or more ED visits (AUC = 0.628–0.634) and hospital admission (AUC = 0.617–0.664).ConclusionsThe findings of this study support the external validity of the DIVERT scale. More specifically, the predictive accuracy of the DIVERT scale from the original work was similar to the accuracy demonstrated within a new cohort, created from different geographical regions and time periods.
Highlights
The Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) scale was developed to classify and estimate the risk of emergency department (ED) use among home care clients
Sample characteristics Within the four regions of our study, we identified 1, 001,133 Resident assessment instrument - home care (RAI-HC) assessed cases occurring between April 1, 2011 and September 30, 2014
The vast majority of cases were in Ontario (88%), followed by Alberta (8%), Winnipeg (4%) and Whitehorse (< 1%)
Summary
Emergency departments (ED) are a common access point for older adults in search of medical attention [1, 2]. To better support the needs of older adults, clinicians, researchers and policymakers have placed a greater emphasis on improving community-based disease management and service integration in an attempt to prevent avoidable ED visitation [6]. One-quarter of older adults in Canada are receiving home care services, with the rate of home care enrollment increasing with age [7, 8]. Older home care clients are a medically complex cohort with relatively poor access to effective chronic disease management. Prior work has demonstrated the utility of prognostic tools and home-based services in supporting the identification of community-dwelling older adults at risk for ED visitation [10,11,12,13]
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