Predicting readmission and death after hospital discharge: a comparison of conventional frailty measurement with an electronic health record-based score

Link to article at PubMed

Age Ageing. 2021 Mar 25:afab043. doi: 10.1093/ageing/afab043. Online ahead of print.


BACKGROUND: frailty measurement may identify patients at risk of decline after hospital discharge, but many measures require specialist review and/or additional testing.

OBJECTIVE: to compare validated frailty tools with routine electronic health record (EHR) data at hospital discharge, for associations with readmission or death.

DESIGN: observational cohort study.

SETTING: hospital ward.

SUBJECTS: consented cardiology inpatients ≥70 years old within 24 hours of discharge.

METHODS: patients underwent Fried, Short Physical Performance Battery (SPPB), PRISMA-7 and Clinical Frailty Scale (CFS) assessments. An EHR risk score was derived from the proportion of 31 possible frailty markers present. Electronic follow-up was completed for a primary outcome of 90-day readmission or death. Secondary outcomes were mortality and days alive at home ('home time') at 12 months.

RESULTS: in total, 186 patients were included (79 ± 6 years old, 64% males). The primary outcome occurred in 55 (30%) patients. Fried (hazard ratio [HR] 1.47 per standard deviation [SD] increase, 95% confidence interval [CI] 1.18-1.81, P < 0.001), CFS (HR 1.24 per SD increase, 95% CI 1.01-1.51, P = 0.04) and EHR risk scores (HR 1.35 per SD increase, 95% CI 1.02-1.78, P = 0.04) were independently associated with the primary outcome after adjustment for age, sex and co-morbidity, but the SPPB and PRISMA-7 were not. The EHR risk score was independently associated with mortality and home time at 12 months.

CONCLUSIONS: frailty measurement at hospital discharge identifies patients at risk of poorer outcomes. An EHR-based risk score appeared equivalent to validated frailty tools and may be automated to screen patients at scale, but this requires further validation.

PMID:33770164 | DOI:10.1093/ageing/afab043

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