The relationship between Elder Risk Assessment Index score and 30-day readmission from the nursing home.

Paul Y Takahashi, Anupam Chandra, Stephen Cha, Aleta Borrud

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Preventable early readmission to the hospital is expensive, and identification of patients at risk is an important task for health care providers. The objective of this study was to determine the relationship between a high score on the Elder Risk Assessment (ERA) Index and 30-day readmission to the hospital in older patients discharged to a nursing home. Patients aged > 60 years residing in the community on January 1, 2005 and subsequently admitted to a local nursing home following hospitalization were included. The cohort was selected from all patients in a primary care internal medicine practice in Rochester, MN. This was a retrospective cohort study that used an electronically archived administrative risk index, the ERA Index, which was derived from demographic and clinical factors. The primary outcome was hospital readmission within 30 days following initial admission to a nursing home. The predictor variable was the ERA Index score. Univariate association between the total ERA Index score and individual components of the ERA Index and 30-day rehospitalization were determined. The ERA Index score cutoff with optimal sensitivity and specificity for hospital readmission was also identified. Of 12 650 patients in the population, 800 were admitted to a facility between 2005 and 2007. Thirty-day readmission was not higher in the group with the highest ERA Index score (top quartile), with a relative risk of 1.72 (95% confidence interval [CI], 0.93-3.56) compared with the lowest-scoring group. The second- and third-highest quartiles were significantly associated with higher 30-day readmission. The individual component of the ERA Index that had the strongest association with early readmission was dementia, with an odds ratio of 2.69 (95% CI, 1.71-4.23). A cutoff score of 5 on the ERA Index resulted in a sensitivity of 0.81 and a specificity of 0.34 with an area under the curve of 0.55. Those with the highest ERA Index score, the top quartile, were not at risk for early hospital readmission. The ERA Index does not predict readmissions from the nursing home to the hospital. There is a need to develop a unique index to predict rehospitalizations in nursing home residents.

Original languageEnglish (US)
Pages (from-to)91-96
Number of pages6
JournalHospital practice (1995)
Volume39
Issue number1
StatePublished - Feb 2011

Fingerprint

Nursing Homes
Patient Readmission
Confidence Intervals
Internal Medicine
Health Personnel
Area Under Curve
Dementia
Primary Health Care
Hospitalization
Cohort Studies
Retrospective Studies
Odds Ratio
Demography
Sensitivity and Specificity

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The relationship between Elder Risk Assessment Index score and 30-day readmission from the nursing home. / Takahashi, Paul Y; Chandra, Anupam; Cha, Stephen; Borrud, Aleta.

In: Hospital practice (1995), Vol. 39, No. 1, 02.2011, p. 91-96.

Research output: Contribution to journalArticle

@article{df5b74f4bea143ec88c8eb908f6fbd52,
title = "The relationship between Elder Risk Assessment Index score and 30-day readmission from the nursing home.",
abstract = "Preventable early readmission to the hospital is expensive, and identification of patients at risk is an important task for health care providers. The objective of this study was to determine the relationship between a high score on the Elder Risk Assessment (ERA) Index and 30-day readmission to the hospital in older patients discharged to a nursing home. Patients aged > 60 years residing in the community on January 1, 2005 and subsequently admitted to a local nursing home following hospitalization were included. The cohort was selected from all patients in a primary care internal medicine practice in Rochester, MN. This was a retrospective cohort study that used an electronically archived administrative risk index, the ERA Index, which was derived from demographic and clinical factors. The primary outcome was hospital readmission within 30 days following initial admission to a nursing home. The predictor variable was the ERA Index score. Univariate association between the total ERA Index score and individual components of the ERA Index and 30-day rehospitalization were determined. The ERA Index score cutoff with optimal sensitivity and specificity for hospital readmission was also identified. Of 12 650 patients in the population, 800 were admitted to a facility between 2005 and 2007. Thirty-day readmission was not higher in the group with the highest ERA Index score (top quartile), with a relative risk of 1.72 (95{\%} confidence interval [CI], 0.93-3.56) compared with the lowest-scoring group. The second- and third-highest quartiles were significantly associated with higher 30-day readmission. The individual component of the ERA Index that had the strongest association with early readmission was dementia, with an odds ratio of 2.69 (95{\%} CI, 1.71-4.23). A cutoff score of 5 on the ERA Index resulted in a sensitivity of 0.81 and a specificity of 0.34 with an area under the curve of 0.55. Those with the highest ERA Index score, the top quartile, were not at risk for early hospital readmission. The ERA Index does not predict readmissions from the nursing home to the hospital. There is a need to develop a unique index to predict rehospitalizations in nursing home residents.",
author = "Takahashi, {Paul Y} and Anupam Chandra and Stephen Cha and Aleta Borrud",
year = "2011",
month = "2",
language = "English (US)",
volume = "39",
pages = "91--96",
journal = "Hospital practice (1995)",
issn = "2154-8331",
publisher = "Taylor and Francis Ltd.",
number = "1",

}

TY - JOUR

T1 - The relationship between Elder Risk Assessment Index score and 30-day readmission from the nursing home.

AU - Takahashi, Paul Y

AU - Chandra, Anupam

AU - Cha, Stephen

AU - Borrud, Aleta

PY - 2011/2

Y1 - 2011/2

N2 - Preventable early readmission to the hospital is expensive, and identification of patients at risk is an important task for health care providers. The objective of this study was to determine the relationship between a high score on the Elder Risk Assessment (ERA) Index and 30-day readmission to the hospital in older patients discharged to a nursing home. Patients aged > 60 years residing in the community on January 1, 2005 and subsequently admitted to a local nursing home following hospitalization were included. The cohort was selected from all patients in a primary care internal medicine practice in Rochester, MN. This was a retrospective cohort study that used an electronically archived administrative risk index, the ERA Index, which was derived from demographic and clinical factors. The primary outcome was hospital readmission within 30 days following initial admission to a nursing home. The predictor variable was the ERA Index score. Univariate association between the total ERA Index score and individual components of the ERA Index and 30-day rehospitalization were determined. The ERA Index score cutoff with optimal sensitivity and specificity for hospital readmission was also identified. Of 12 650 patients in the population, 800 were admitted to a facility between 2005 and 2007. Thirty-day readmission was not higher in the group with the highest ERA Index score (top quartile), with a relative risk of 1.72 (95% confidence interval [CI], 0.93-3.56) compared with the lowest-scoring group. The second- and third-highest quartiles were significantly associated with higher 30-day readmission. The individual component of the ERA Index that had the strongest association with early readmission was dementia, with an odds ratio of 2.69 (95% CI, 1.71-4.23). A cutoff score of 5 on the ERA Index resulted in a sensitivity of 0.81 and a specificity of 0.34 with an area under the curve of 0.55. Those with the highest ERA Index score, the top quartile, were not at risk for early hospital readmission. The ERA Index does not predict readmissions from the nursing home to the hospital. There is a need to develop a unique index to predict rehospitalizations in nursing home residents.

AB - Preventable early readmission to the hospital is expensive, and identification of patients at risk is an important task for health care providers. The objective of this study was to determine the relationship between a high score on the Elder Risk Assessment (ERA) Index and 30-day readmission to the hospital in older patients discharged to a nursing home. Patients aged > 60 years residing in the community on January 1, 2005 and subsequently admitted to a local nursing home following hospitalization were included. The cohort was selected from all patients in a primary care internal medicine practice in Rochester, MN. This was a retrospective cohort study that used an electronically archived administrative risk index, the ERA Index, which was derived from demographic and clinical factors. The primary outcome was hospital readmission within 30 days following initial admission to a nursing home. The predictor variable was the ERA Index score. Univariate association between the total ERA Index score and individual components of the ERA Index and 30-day rehospitalization were determined. The ERA Index score cutoff with optimal sensitivity and specificity for hospital readmission was also identified. Of 12 650 patients in the population, 800 were admitted to a facility between 2005 and 2007. Thirty-day readmission was not higher in the group with the highest ERA Index score (top quartile), with a relative risk of 1.72 (95% confidence interval [CI], 0.93-3.56) compared with the lowest-scoring group. The second- and third-highest quartiles were significantly associated with higher 30-day readmission. The individual component of the ERA Index that had the strongest association with early readmission was dementia, with an odds ratio of 2.69 (95% CI, 1.71-4.23). A cutoff score of 5 on the ERA Index resulted in a sensitivity of 0.81 and a specificity of 0.34 with an area under the curve of 0.55. Those with the highest ERA Index score, the top quartile, were not at risk for early hospital readmission. The ERA Index does not predict readmissions from the nursing home to the hospital. There is a need to develop a unique index to predict rehospitalizations in nursing home residents.

UR - http://www.scopus.com/inward/record.url?scp=79957851767&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79957851767&partnerID=8YFLogxK

M3 - Article

C2 - 21441764

AN - SCOPUS:79957851767

VL - 39

SP - 91

EP - 96

JO - Hospital practice (1995)

JF - Hospital practice (1995)

SN - 2154-8331

IS - 1

ER -