Key result
The DIVERT scale predicted unplanned hospitalizations in home care clients with an overall area under the curve of 0.62, performing better in clients under 70 years of age (AUC 0.71).
Why the study?
Predictive case-finding tools were needed to classify the risk of unplanned hospitalization among home care clients using the Resident Assessment Instrument-Home Care, particularly evaluating the DIVERT Scale.
Does the DIVERT Scale accurately predict unplanned hospitalization in home care clients?
Cohort (n=3,091)
Does the DIVERT Scale accurately predict unplanned hospitalization in home care clients?
Effect estimate: AUC 0.62 (95% CI 0.61-0.64)
The DIVERT scale offers a modest approach to predicting unplanned hospitalizations in home care clients, performing best in those under 70 years of age.
May aid risk stratification among elderly home care clients; leaves open prospective validation before clinical adoption.
PURPOSE: To identify predictive case finding tools for classifying the risk of unplanned hospitalization among home care clients utilizing the Resident Assessment Instrument-Home Care (RAI-HC), with special interest in the Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) Scale. METHODS: A register-based, retrospective study based on the RAI-HC assessments of 3,091 home care clients (mean age 80.9 years) in the City of Tampere, Finland, linked with hospital discharge records. The outcome was an unplanned hospitalization within 180 days after RAI-HC assessment. The Area Under the Curve (AUC) and the sensitivity and specificity were determined for the RAI-HC scales: DIVERT, Activities of Daily Living Hierarchy (ADLh), Cognitive Performance Scale (CPS), Changes in Health, End-Stage Diseases, Signs, and Symptoms Scale (CHESS), and Method for Assigning Priority Levels (MAPLe). RESULTS: Altogether 3091 home care clients had a total of 7744 RAI-HC assessments, of which 1658 (21.4%) were followed by an unplanned hospitalization. The DIVERT Scale had an AUC of 0.62 (95% confidence interval 0.61-0.64) when all assessments were taken into account, but its value was poorer in the older age groups (< 70 years: 0.71 (0.65-0.77), 70-79 years: 0.66 (0.62-0.69), 80-89 years: 0.60 (0.58-0.62), ≥ 90 years: 0.59 (0.56-0.63)). AUCs for the other scales were poorer than those of DIVERT, with CHESS nearest to DIVERT. Time to hospitalization after assessment was shorter in higher DIVERT classes. CONCLUSION: The DIVERT Scale offers an approach to predicting unplanned hospitalization, especially among younger home care clients. Clients scoring high in the DIVERT algorithm were at the greatest risk of unplanned hospitalization and more likely to experience the outcome earlier than others.
No takes yet. Share an insight, caveat, or question.
Rönneikkö et al. (2022) conducted a cohort in Home care clients at risk of unplanned hospitalization (n=3,091). DIVERT Scale vs. Other RAI-HC scales was evaluated on Unplanned hospitalization within 180 days after RAI-HC assessment (AUC 0.62, 95% CI 0.61-0.64). The DIVERT scale predicted unplanned hospitalizations in home care clients with an overall area under the curve of 0.62, performing better in clients under 70 years of age (AUC 0.71).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: