Future Hospital Admissions Research Articles

Patient-Reported Outcomes Predict Future Emergency Department Visits and Hospital Admissions in Patients With Stroke.

BackgroundIdentification of stroke patients at increased risk of emergency department (ED) visits or hospital admissions allows implementation of mitigation strategies. We evaluated the ability of the Patient‐Reported Outcomes Information Measurement System (PROMIS) patient‐reported outcomes (PROs) collected as part of routine care to predict 1‐year emergency department (ED) visits and admissions when added to other readily available clinical variables.Methods and ResultsThis was a cohort study of 1696 patients with ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or transient ischemic attack seen in a cerebrovascular clinic from February 17, 2015, to June 11, 2018, who completed the following PROs at the visit: Patient Health Questionnaire‐9, Quality of Life in Neurological Disorders cognitive function, PROMIS Global Health, sleep disturbance, fatigue, anxiety, social role satisfaction, physical function, and pain interference. A series of logistic regression models was constructed to determine the ability of models that include PRO scores to predict 1‐year ED visits and all‐cause and unplanned admissions. In the 1 year following the PRO encounter date, 1046 ED visits occurred in 548 patients; 751 admissions occurred in 453 patients. All PROs were significantly associated with future ED visits and admissions except PROMIS sleep. Models predicting unplanned admissions had highest optimism‐corrected area under the curve (range, 0.684–0.724), followed by ED visits (range, 0.674–0.691) and then all‐cause admissions (range, 0.628–0.671). PROs measuring domains of mental health had stronger associations with ED visits; PROs measuring domains of physical health had stronger associations with admissions.ConclusionsPROMIS scales improve the ability to predict ED visits and admissions in patients with stroke. The differences in model performance and the most influential PROs in the prediction models suggest differences in factors influencing future hospital admissions and ED visits.

Potential lethality of suicide attempts in youth.

Rates of suicide in youth have increased over the last 50years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.

Indicators of dementia disease progression in primary care: An electronic health record cohort study.

The objectives were to assess the feasibility and validity of using markers of dementia-related health as indicators of dementia progression in primary care, by assessing the frequency with which they are recorded and by testing the hypothesis that they are associated with recognised outcomes of dementia. The markers, in 13 domains, were derived previously through literature review, expert consensus, and analysis of regional primary care records. The study population consisted of patients with a recorded dementia diagnosis in the Clinical Practice Research Datalink, a UK primary care database linked to secondary care records. Incidence of recorded domains in the 36months after diagnosis was determined. Associations of recording of domains with future hospital admission, palliative care, and mortality were derived. There were 30,463 people with diagnosed dementia. Incidence of domains ranged from 469/1000 person-years (Increased Multimorbidity) to 11/1000 (Home Pressures). An increasing number of domains in which a new marker was recorded in the first year after diagnosis was associated with hospital admission (hazard ratio for ≥4 domains vs. no domains = 1.24; 95% confidence interval = 1.15-1.33), palliative care (1.87; 1.62-2.15), and mortality (1.57; 1.47-1.67). Individual domains were associated with outcomes with varying strengths of association. Feasibility and validity of potential indicators of progression of dementia derived from primary care records are supported by their frequency of recording and associations with recognised outcomes. Further research should assess whether these markers can help identify patients with poorer prognosis to improve outcomes through stratified care and targeted support.

P085 Impact of COVID-19 on hospital services and specialist care of adults with cystic fibrosis

Objectives: The aim of this study is to examine the impact of the COVID-19 lockdown on hospital services and specialist care of adults with cystic fibrosis (PWCF) in Ireland. Methods: A cross-sectional survey was undertaken. The consent and questionnaire were hosted on SmartSurveyUK. The survey was advertised widely by Cystic Fibrosis Ireland to the CF community via CF website, Twitter, Instagram, Facebook and through WhatsApp groups during September/October 2020. Results: 118 PWCF responded and 56 (47.5%) indicated a deferral of hospital visits for CF care. The period of delay ranged from 1 to 6 months, with 57.4% to three months and 42.6% to over 6 months. Key reasons for deferral amongst those who deferred (n = 56) were fear of infection from coronavirus (69.8%) and hospital unit closed (11.5%). Amongst PWCF who deferred, deferrals impacted rehabilitation therapies (n = 25%), medical care at hospital (n = 65.6%), surgery (n = 6.3%), and appointment with GP (n = 34.4%). More respondents aged 35 and over had to cancel/postpone diagnostic tests compared to those <35 years (64% vs 36%: NS). Non-significantly greater proportions of females postponed therapy and tests. Online consultation was new for more than half of the participants (51.7%) and the majority (88.8%) found it useful. Little over half of the participants (53%) had access to prescription via email and majority of those who used (98.4%) found it useful. Conclusion: The COVID-19 pandemic has impacted many PWCF in terms of access to tests and specialist care. Time will tell how this will impact on future hospital admissions and survival. Online consultation and emailed prescriptions were both positively received by many. Prescription renewal via email is certainly a consideration to be continued post-pandemic.

Cannabis use disorder and the future risk of cardiovascular disease in parous women: a longitudinal cohort study

BackgroundCannabis use is increasing in women of reproductive age, but whether cannabis use disorders increase the long-term risk of cardiovascular disease in this population is not known. Cannabis may cause tachycardia, hypertension, cerebral vasoconstriction, and other adverse cardiovascular effects and has been associated with acute myocardial infarction and stroke. Data on the long-term effects of cannabis on the cardiovascular system are more limited. We assessed the relationship between cannabis use disorders early in life and the future risk of cardiovascular disease in women.MethodsWe analyzed a longitudinal cohort of 1,247,035 pregnant women in Quebec, Canada, between 1989 and 2019. The main exposure was current or past history of cannabis use disorders at cohort entry. The main outcome measure included future hospital admission for any cardiovascular disorder during 18,998,986 person years of follow-up. We used Cox proportional hazards regression models adjusted for patient characteristics to compute hazard ratios (HR) and 95% confidence intervals (CI) for the association of cannabis use disorder with the later risk of cardiovascular hospitalization.ResultsWomen with cannabis use disorders had a higher incidence of cardiovascular hospitalization than unexposed women (58.4 vs. 33.6 per 10,000 person years). Cannabis use disorder was associated with 1.48 times the risk of cardiovascular hospitalization (95% CI 1.27–1.72), compared with no cannabis use disorder. The association was greater for cannabis with concomitant use of other substances (HR 1.84, 95% CI 1.53–2.21) than for cannabis alone (HR 1.30, 95% CI 0.99–1.72). Cannabis use disorder was strongly associated with hemorrhagic stroke, even with adjustment for other substance use (HR 2.08, CI 1.07–4.05).ConclusionsCannabis use disorders may increase the long-term risk of cardiovascular disease in women, particularly hemorrhagic stroke. However, some of the excess risk may be due to concomitant use of other substances.

The Association Between Self-reported Participation and Quality of Life and Future Hospitalizations in Ambulatory Adults with Spinal Cord Injury

To link data sources and examine the relationships between self-reported participation and quality of life (QOL) indicators and future hospital admissions among ambulatory adults with chronic spinal cord injury (SCI).

Sociodemographic and lifestyle predictors of incident hospital admissions with multimorbidity in a general population, 1999–2019: the EPIC-Norfolk cohort

BackgroundThe ageing population and prevalence of long-term disorders with multimorbidity are a major health challenge worldwide. The associations between comorbid conditions and mortality risk are well established; however, few prospective...

Cohort Study of Outpatient Hemodialysis Management Strategies for COVID-19 in North-West London

BackgroundDialysis patients are at risk of severe coronavirus disease 2019 (COVID-19). We managed COVID-19 hemodialysis outpatients in dedicated satellite dialysis units. This provided rare opportunity to study early disease progress in community-based patients. We aimed to (i) understand COVID-19 progression, (ii) identify markers of future clinical severity, and (iii) assess associations between dialysis management strategies and COVID-19 clinical outcomes.MethodsWe conducted a cohort study of all outpatients managed at a COVID-19 hemodialysis unit. We analyzed data recorded as part of providing COVID-19 clinical care. We analyzed associations between features at diagnosis and the first 3 consecutive hemodialysis sessions in patients who required future hospital admission, and those who had died at 28 days.ResultsIsolated outpatient hemodialysis was provided to 106 patients over 8 weeks. No patients received antiviral medication or hydroxychloroquine. Twenty-one patients (20%) were admitted at COVID-19 diagnosis; 29 of 85 patients (34%) were admitted after initial outpatient management; 16 patients (15%) died. By multivariate analysis, nonactive transplant list status, use of institutional transport, and increased white cell count associated with future hospitalization and increased age associated with death. Oxygen saturations progressively decreased over the first 3 dialysis sessions in the cohorts that progressed to future hospital admission or death. Mean ultrafiltration volume of the first 3 hemodialysis sessions was reduced in the same cohorts.ConclusionsOutpatient hemodialysis in patients with COVID-19 is safe for patients and staff. Features at the first 3 dialysis sessions can identify individuals at risk of future hospitalization and death from COVID-19.

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

The challenges of COVID-19 for people with dementia with Lewy bodies and family caregivers.

Social Isolation Associated with Future Health Care Utilization.

Social isolation among individuals ages 65 years and older is associated with poor health outcomes. However, little is known about health care utilization patterns of socially isolated individuals. This retrospective, observational study evaluated associations between social isolation and hospital and emergency department (ED) utilization among Medicare patients ages 65 years and older. In a cohort of 18,557 Medicare members age 65 years and older at Kaiser Permanente Northwest, the authors compared rates of hospitalization and ED visits in the 12 months following a baseline survey between respondents who reported feeling lonely or socially isolated and those who did not, controlling for demographic and health variables and utilization in the 12 months prior to the survey. Statistical analysis was conducted in February 2020. In adjusted models, those who reported "sometimes" experiencing social isolation were more likely to have at least 1 hospital admission (odds ratio [ORsometimes]: 1.17, 95% confidence interval [CI]: 1.01-1.35, P = 0.04), than those who "rarely" or "never" experienced social isolation. Those who experienced social isolation "sometimes" or "often/always" were more likely to have at least 1 ED visit (ORsometimes: 1.28, 95% CI: 1.15-1.41, P < 0.0001, and ORoften/always: 1.51, 95% CI: 1.25-1.84, P < 0.0001, respectively) than those who "rarely" or "never" experienced social isolation. These findings suggest that self-reported social isolation may be predictive of future hospital admissions and ED utilization. Research is needed to determine how addressing social isolation needs within the health care system affects health care utilization and health outcomes.

The association between participation and quality of life indicators with hospitalizations in ambulatory adults with spinal cord injury.

Statistical modeling of self-report assessments (SRA) as predictors of future hospitalizations, measured by administrative billing data. To examine the relationships between self-reported participation and quality of life (QOL) indicators and future hospital admissions among ambulatory adults with chronic spinal cord injury (SCI). Data were collected from participants living in and utilizing hospitals in the state of South Carolina. Participants were identified through the South Carolina SCI Surveillance System Registry. Between 2011 and 2015, 615 ambulatory adults (>18 years old) with chronic (>1-year), traumatic SCI completed mailed SRA. Participant socio-demographic, injury, health, participation, and QOL indicators were assessed using self-report data. Administrative billing data were used to measure hospital utilization in nonfederal, South Carolina hospitals in the year following the SRA. Prior year discharges, current pressure ulcers, number of chronic conditions, walking 150 feet more often (never, less than once per week, at least once per week, once or twice per day, or several times per day), and greater home life satisfaction were associated with an increased risk of subsequent hospitalization. Walking 10 feet more frequently and greater global satisfaction were associated with a decreased risk of hospital admission. Specific participation and QOL items may increase the risk of hospitalization in ambulatory adults with SCI. Further study is necessary to understand better the relationships between walking distance and frequency, home life and global satisfaction, and inpatient admissions.

Acute Heart Failure Comorbidome: The Impact of Everything Else.

Heart failure frequently coexists with several comorbidities. Our aim is to evaluate the prognostic role of various comorbiditiesin the risk of acute heart failure development. Comorbidities of patients with acute heart failure were, retrospectively, compared to a control group of patientswith chronic heart failure admitted to an Internal Medicine unit in a 2-year period. Logistic regression models were constructed to determinetheir association with acute heart failure and to develop a comorbidome. We identified 229 patients with acute heart failure and 201 patients with chronic heart failure. Age and female gender werehigher in acute heart failure group (p < 0.001) as was the number of comorbidities (4.0 ± 3.0 vs 4.0 ± 2.0, p = 0.044). Hyperuricemia(odds ratio 2.46, confidence interval 95% 1.41 - 4.31, p = 0.002), obesity (odds ratio 2.22, confidence interval 95% 1.31 - 3.76, p =0.003), atrial fibrillation (odds ratio 1.93, confidence interval 95% 1.31 - 2.87, p = 0.001), peripheral artery disease (odds ratio 2.12,confidence interval 95% 1.01 - 4.42, p = 0.046) and chronic kidney disease (odds ratio 2.47, confidence interval 95% 1.65 - 3.71, p <0.001) were associated with acute heart failure. Obesity, atrial fibrillation, peripheral artery disease and chronic kidney disease wereidentified as independent risk factors. Patients with multiple comorbidities had a superior risk of hospitalization due to heart failure: zerocomorbidities - odds ratio 0.43, 95% confidence interval 0.28 - 0.67, p < 0.001; one comorbidity - odds ratio 0.69, 95% confidenceinterval 0.47 - 1.01, p = 0.057; two comorbidities - odds ratio 1.85, 95% confidence interval 1.11 - 3.08, p = 0.019; ≥ three comorbidities- odds ratio 5.81, 95% confidence interval 2.77 - 12.16, p < 0.001. This study shows an association between several comorbidities and hospital admission due to acute heart failure. Theassociation seems to strengthen in the presence of multiple comorbidities. A comorbidome is a useful tool to identify comorbidities associated with higher risk of acute heart failure. The identificationof vulnerable patients may allow multidimensional interventions to minimize future hospital admissions.

1332. Identification of Genetic Markers Linked to Recurrent Methicillin-Resistant Staphylococcus aureus Skin and Soft-Tissue Infections

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most common and problematic causes of bacterial skin and soft-tissue infections (SSTI). MRSA tends to form complex skin infections, furuncles, boils and abscesses. Many patients go on to have recurrent infections, requiring significant additional therapy to treat each infection as well as needing to undergo decolonization of the skin in order to remove the bacteria and try to prevent future infections. A test to distinguish patients at risk for recurrence can allow earlier more aggressive treatment for those at risk for recurrent infection. This can potentially reduce healthcare costs, prevent future hospital admissions and surgical procedures, and reduce loss of productivity experienced by patients suffering from multiple recurrences.MethodsA genome-wide association study using the Affymetrix gene array was performed on 11 patients with confirmed recurrent MRSA SSTIs and 3 controls who never developed an SSTI despite confirmed heavy exposure to MRSA in order to identify single nucleotide polymorphisms (SNP) associated with recurrent MRSA. The 10 genes identified were then fully sequenced using an Illumina NextSeq 500 to identify additional SNPs.ResultsA total of 22 SNPs were found in 10 separate genes which distinguished patients with recurrent MRSA from patients without recurrent MRSA despite heavy exposure. The 10 genes are shown in Table 1 along with a representative SNP. The P-values for each individual SNP were between 3.5 × 10−5 and 1.2 × 10−7.ConclusionThis study provides the first evidence of a genetic risk for those patients who develop recurrent MRSA SSTIs. The majority of the genes involved are related directly to the skin, not to immune functions thus it appears the major risk factor for development of recurrent MRSA SSTI is related to the barrier function of the skin and not to an immune defect. Being able to determine which patients are at risk for recurrence at the time they first present with an MRSA SSTI would be of great help in preventing future recurrences, reducing morbidity and reducing healthcare costs. Disclosures All authors: No reported disclosures.

Prevalence of Chronic Health Conditions and Association with Hospital Utilization in Adults with Chronic SCI

To 1) identify the self-reported prevalence of seven chronic health conditions (CHCs) in adults with chronic, traumatic spinal cord injury (SCI), 2) examine the relationships between the presence of CHC with future hospital admissions and total number of inpatient days and 3) identify predictors of utilization.

Effectiveness of a brief intervention aimed at increasing distress tolerance for individuals in crisis or at risk of self-harm.

This study evaluated a brief psychological intervention aimed at improving distress tolerance and decreasing future admissions for individuals presenting to a mental health service in the context of crisis or self-harm. Eighty-five participants completed The Crisis Intervention Package at the point of contact with the mental health service. The outcome of the intervention was evaluated through pre- and post-scores on the Distress Tolerance Scale and future hospital admissions. Participants showed a significant improvement in Distress Tolerance Scale scores (P < 0.001) indicating an increase in ability to tolerate distressing emotions. Additionally, there was a significant decrease in hospital admissions 6 months pre-test to 6 months post-test. The results demonstrate the potential effectiveness of structured, brief interventions aimed at increasing distress tolerance and self-management skills for individuals presenting to a mental health service in crisis.

Associations between Health-Related Quality of Life and Self-Reported Emergency Room Department Visits and Inpatient Hospitalizations: Insights from a Secondary Data Analysis of Patients with Light-Chain (AL) Amyloidosis.

IntroductionLight-chain (AL) amyloidosis is a rare, progressive, and typically fatal disease. Health-related quality of life (HRQoL) has been shown to be a significant prognostic factor associated with clinical outcomes such as survival and response to treatment. A better understanding of how patterns of HRQoL may be prospectively associated with costly healthcare resource utilization, such as emergency department (ED) visits and inpatient hospitalizations, is warranted.MethodsA secondary data analysis of a non-interventional, longitudinal online study of patients with AL amyloidosis (n = 224) was conducted. Negative binomial regression models were used to examine whether initial HRQoL scores (as measured by the SF-36v2® Health Survey [SF-36v2], where higher scores reflect better HRQoL) and changes in HRQoL were associated with the number of ED visits and inpatient hospitalizations during a 12-month period. Incidence rate ratios were interpreted by 5-point decrements in initial HRQoL scores and minimally important changes in HRQoL change scores.ResultsThere were significant inverse associations between initial SF-36v2 scores and subsequent rates of ED visits and inpatient hospitalizations across all domains and summary components (p < 0.05 for all). In contrast, changes in physical, but not mental, functioning were associated with rates of ED visits and inpatient hospitalizations during a 12-month period of observation.ConclusionScores from patient-reported HRQoL surveys may be helpful in identifying patients at risk of future ED visits and hospital admissions, and may serve as a proxy for disease severity. Such information can provide stakeholders with insight into the humanistic and societal cost associated with AL amyloidosis.

Prevalence of chronic health conditions and hospital utilization in adults with spinal cord injury: an analysis of self-report and South Carolina administrative billing data.

Retrospective analysis of self-report and administrative billing data. (1) Identify the self-reported prevalence of seven chronic health conditions (CHCs) in adults with chronic, traumatic spinal cord injury (SCI), (2) Examine the relationships between the presence of CHC with future hospital admissions and total number of inpatient days and (3) identify predictors of utilization. Data were collected from participants living in and utilizing hospitals in South Carolina, USA. Participants were identified through the South Carolina SCI Surveillance System Registry. Between 2010 and 2013, 963 adults ( > 18 years old) with chronic ( > 1-year), traumatic SCI completed self-report assessments (SRAs); this analysis includes data from 787 individuals. The presence/absence of the seven CHC was assessed using self-report data. Administrative billing data were used to assess hospital utilization in non-federal, South Carolina hospitals in the year following the SRA. In all, 40.5% reported no CHC; 23.4% reported one CHC and 36.1% reported having two or more CHC. The most commonly reported CHCs were hypertension (43.1%), high cholesterol (32.2%) and diabetes (15.8%). In total, 59% had at least one hospital admission in the year following the SRA (mean 3 ± 5; range 0-45; median = 1). The mean total inpatient days was 15.7 ± 43 days (range 0-365; median = 1). Predictors of hospital admission included CHC, pressure sores, education, prior hospitalization and injury severity. With the exception of CHC, each was also associated with total number of inpatient days. CHC are prevalent and associated with hospital admissions in adults with chronic, traumatic SCI.

Pharmacists’ Impact on Secondary Stroke Prevention

Background: Patients admitted to our institution with a cerebrovascular accident (stroke) or transient ischemic attack (TIA) are referred to the pharmacist-run stroke prevention clinic (SPC) for medication and risk factor management. Objective: The objective was to determine if patients receiving care from the SPC have better outcomes than patients who received usual care. Methods: This was a retrospective chart review of patients referred to the SPC. At the time of stroke/TIA, before initial visit, and after last SPC visit, risk factor data was collected. Hospital readmissions were reviewed for secondary stroke/TIA, myocardial infarction (MI), and new or incidental peripheral artery disease (PAD). For patients that did not attend SPC visits, data was used as a control. Results: Patients referred to the SPC from October 2012 to December 2014 were reviewed. 455 records were reviewed. The primary composite end point of readmission for stroke/TIA, myocardial infarction, and new or incidental PAD was statistically significantly lower in the SPC group than the control group (P = .013). All surrogate markers, including blood pressure, Low Density Lipoprotein, Hemoglobin A1c, and smoking status, improved in the SPC group. Conclusion: Pharmacists can play a role in reducing risk factors for secondary stroke/TIA and prevent future hospital admissions.

Risk stratification at primary care centres in Valencia (Spain) to activate integrated care pathways for elderly patients with chronic conditions

Introduction : The activation of integrated care pathways is not always easy and is time-consuming, so the standardized use of stratification tools (ST) can support health care professionals in decision-making processes. Several ST –developed and validated in the United States– have been implemented in the Valencia Region (Spain) at primary care (PC) centres to identify elders with multimorbidity at risk of suffering future hospital admissions (FHA). In spite of the usefulness of these instruments, it would be recommended to apply STs which have been specifically designed on the basis of the Spanish healthcare system and the characteristics of its population. Thus, the objective of this study was to design a ST aimed at the identification of elders at risk of hospital admissions in the following 12 months in the Valencian Healthcare System. Methods : The study started with the organization of focus groups (FG) with six multidisciplinary PC professionals aimed at selecting potential variables to be included in the ST. From the FG’s results a retrospective study was carried out with the objective of identifying the most significant variables. These variables were tested in a sample of 107 elders. In the last stage, the combination of variables derived from the previous steps was tested in a sample of 1,000 patients in order to select a final combination of variables and to build a predictive algorithm through binary logistic regression analysis. Results : A set of 13 potential variables to be included in our ST were identified in the FG. These variables comprised data on socio-demographics, clinical and social aspects and registers on the previous use of health resources. As part of the retrospective studies, binary logistic regression analysis determined that the following variables were statistically significant as predictors of FHA: ‘chronic respiratory disease’ (OR= 2.32, p= 0.015), ‘chronic heart disease’ (OR= 2.10, p= 0.019), ‘palliative care’ (OR= 22.53, p= 0.04), and the ‘number of previous visits to emergency department at hospital’ (OR= 1.82, p Discussions : The model developed within this study has shown an optimal performance, and an acceptable ability to identify patients at high risk of FHA who really were admitted (sensitivity of 42%), an excellent ability to identify patients at low risk who really did not suffer any admission (specificity of 96%). The accuracy detecting patients was similar to other comparable studies or even higher with reported AUC of 0.764. Moreover, the model incorporates variables that can be collected automatically from electronic health information systems (eHIS). Furthermore, the experts participating in the FG highlighted some social variables – usually not registered within eHIS – as determinants of health, especially in elders with chronic conditions (such as availability of knowledge and skills for appropriate self-care, social and/or family support or economic difficulties). Thus, it is proposed a 2-phase stratification system: the first one will calculate the developed algorithm through eHIS, and the second one will assess social variables by consulting the professional of reference. Conclusions : The final predictive model is composed by variables available at eHIS, so it can be easily introduced into health administration system of the Valencia Region. From this screening and decision-making support ST, professionals will be able to implement a wide range of care plans in accordance with patients’ health and social needs which can potentially improve quality of care and favor that older people can remain at home longer. Lessons learned : It is possible to design new ST on the basis of the target population profile and the characteristics of the healthcare system. Limitations : The sample is not representative of the whole elderly population in the Valencia Region. Moreover, the sensitivity of the model is limited. Suggestions for future research : Future studies are needed to validate these results with a larger sample from the Valencia Region and other regions in Spain. Moreover, it would be interesting to explore their applicability in other health and social care settings and even in other European contexts assessing the degree of similarity or variance of discriminating factors or the available electronic data sets. Currently, we continue this study developing an integrated care protocol to be implemented in those patients identified as high risk of suffering FHA by a multidisciplinary team of PC professionals (general practitioners, nurses and social workers).

Patient choice modelling: how do patients choose their hospitals?

As an aid to predicting future hospital admissions, we compare use of the Multinomial Logit and the Utility Maximising Nested Logit models to describe how patients choose their hospitals. The models are fitted to real data from Derbyshire, United Kingdom, which lists the postcodes of more than 200,000 admissions to six different local hospitals. Both elective and emergency admissions are analysed for this mixed urban/rural area. For characteristics that may affect a patient’s choice of hospital, we consider the distance of the patient from the hospital, the number of beds at the hospital and the number of car parking spaces available at the hospital, as well as several statistics publicly available on National Health Service (NHS) websites: an average waiting time, the patient survey score for ward cleanliness, the patient safety score and the inpatient survey score for overall care. The Multinomial Logit model is successfully fitted to the data. Results obtained with the Utility Maximising Nested Logit model show that nesting according to city or town may be invalid for these data; in other words, the choice of hospital does not appear to be preceded by choice of city. In all of the analysis carried out, distance appears to be one of the main influences on a patient’s choice of hospital rather than statistics available on the Internet.