Abstract
BackgroundThe prevention of recurrent hospitalizations in the frail elderly requires the implementation of high-intensity interventions such as case management. In order to be practically and financially sustainable, these programs require a method of identifying those patients most at risk for hospitalization, and therefore most likely to benefit from an intervention. The goal of this study is to demonstrate the use of an electronic medical record to create an administrative index which is able to risk-stratify this heterogeneous population.MethodsWe conducted a retrospective cohort study at a single tertiary care facility in Rochester, Minnesota. Patients included all 12,650 community-dwelling adults age 60 and older assigned to a primary care internal medicine provider on January 1, 2005. Patient risk factors over the previous two years, including demographic characteristics, comorbid diseases, and hospitalizations, were evaluated for significance in a logistic regression model. The primary outcome was the total number of emergency room visits and hospitalizations in the subsequent two years. Risk factors were assigned a score based on their regression coefficient estimate and a total risk score created. This score was evaluated for sensitivity and specificity.ResultsThe final model had an AUC of 0.678 for the primary outcome. Patients in the highest 10% of the risk group had a relative risk of 9.5 for either hospitalization or emergency room visits, and a relative risk of 13.3 for hospitalization in the subsequent two year period.ConclusionsIt is possible to create a screening tool which identifies an elderly population at high risk for hospital and emergency room admission using clinical and administrative data readily available within an electronic medical record.
Highlights
The prevention of recurrent hospitalizations in the frail elderly requires the implementation of highintensity interventions such as case management
The study was a retrospective cohort of all patients age 60 and greater who were impaneled on January 1, 2005, in the Division of Primary Care Internal Medicine (PCIM) at Mayo Clinic in Rochester, MN
There were a total of 13,457 patients in the age range 60 and over in the PCIM panel on January 1, 2005
Summary
The prevention of recurrent hospitalizations in the frail elderly requires the implementation of highintensity interventions such as case management. In order to identify those patients, health care providers require some form of risk assessment to focus their efforts - recognizing that the elderly population is very heterogeneous in function and disease burden. Our group hypothesized that we could identify older adults at high risk for hospitalization or emergency department visits using only information readily available from a centralized electronic health record, without taking time away from staff and patients. This model is becoming increasingly feasible as national policy continues to strongly encourage the creation and use of electronic medical records. The primary aim of this study was to demonstrate that readily accessible information available in a provider’s electronic medical record could be used to identify a population of community dwelling older adults at high-risk for hospitalization or emergency room utilization
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