Predictors of 1-year drug-related admissions in older multimorbid hospitalized adults.

Aubert, Carole E.; Rodondi, Nicolas; Netzer, Seraina; Dalleur, Olivia; Spinewine, Anne; Maanen, Clara Drenth-van; Knol, Wilma; O'Mahony, Denis; Aujesky, Drahomir; Donzé, Jacques (2022). Predictors of 1-year drug-related admissions in older multimorbid hospitalized adults. Journal of the American Geriatrics Society, 70(5), pp. 1510-1516. Wiley-Blackwell 10.1111/jgs.17667

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BACKGROUND

Identifying patients at high risk of drug-related hospital admission (DRA) may help to efficiently target preventive interventions. We developed a score to predict DRAs in older patients with multimorbidity and polypharmacy.

METHODS

We used participants from the multicenter European OPERAM trial ("Optimising PharmacothERapy in the Mutlimorbid Elderly"). We assessed the association between easily identifiable predictors and 1-year DRAs by univariable logistic regression. Variables with p-value< 0.20 were taken forward to backward regression. We retained all variables with p < 0.05 in the model. We assessed the C-statistic, calibration (observed/predicted proportions), and overall accuracy (scaled Brier score, <0.25 indicating a useful model) of the score, and internally validated it by tenfold cross-validation.

RESULTS

Within 1 year, 435/1879 (23.2%) patients (mean age 79.4 years) had a DRA. The score included seven variables: previous hospitalizations, non-elective admission, hypertension, cirrhosis with portal hypertension, chronic kidney disease, diuretic, oral corticosteroid. The C-statistic was 0.64 (95% CI 0.61-0.67). Patients with <1 point had a 12.4% predicted and observed risk of DRA, while those with >3 points had a 40.4% predicted and 38.9% observed risk of DRA. The scaled Brier score was 0.05. Calibration showed an adequate match between predicted and observed proportions.

CONCLUSION

Comorbidities related to drug metabolism, specific medications, non-elective admission, and a history of hospitalization, were associated with a higher risk of DRA. Awareness of these associations and the score we developed may help identify patients most likely to benefit from preventive interventions.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Aubert, Carole Elodie, Rodondi, Nicolas, Netzer, Seraina, Aujesky, Drahomir

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

0002-8614

Publisher:

Wiley-Blackwell

Funders:

[4] Swiss National Science Foundation ; [201] Staatssekretariat für Bildung, Forschung und Innovation (SBFI) = Swiss State Secretariat for Education, Research and Innovation (SERI)

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

27 Jan 2022 17:47

Last Modified:

05 Dec 2022 16:05

Publisher DOI:

10.1111/jgs.17667

PubMed ID:

35064571

Uncontrolled Keywords:

drug-related admission older adult readmission score

BORIS DOI:

10.48350/164850

URI:

https://boris.unibe.ch/id/eprint/164850

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