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The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study
BACKGROUND: The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered wh...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934406/ https://www.ncbi.nlm.nih.gov/pubmed/33733245 http://dx.doi.org/10.1016/S2666-7568(21)00004-0 |
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author | Street, Andrew Maynou, Laia Gilbert, Thomas Stone, Tony Mason, Suzanne Conroy, Simon |
author_facet | Street, Andrew Maynou, Laia Gilbert, Thomas Stone, Tony Mason, Suzanne Conroy, Simon |
author_sort | Street, Andrew |
collection | PubMed |
description | BACKGROUND: The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission. METHODS: This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission. FINDINGS: Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power. INTERPRETATION: We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions. FUNDING: National Institute of Health Research. |
format | Online Article Text |
id | pubmed-7934406 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
record_format | MEDLINE/PubMed |
spelling | pubmed-79344062021-03-15 The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study Street, Andrew Maynou, Laia Gilbert, Thomas Stone, Tony Mason, Suzanne Conroy, Simon Lancet Healthy Longev Articles BACKGROUND: The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission. METHODS: This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission. FINDINGS: Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power. INTERPRETATION: We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions. FUNDING: National Institute of Health Research. 2021-03 /pmc/articles/PMC7934406/ /pubmed/33733245 http://dx.doi.org/10.1016/S2666-7568(21)00004-0 Text en © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Articles Street, Andrew Maynou, Laia Gilbert, Thomas Stone, Tony Mason, Suzanne Conroy, Simon The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title | The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title_full | The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title_fullStr | The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title_full_unstemmed | The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title_short | The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study |
title_sort | use of linked routine data to optimise calculation of the hospital frailty risk score on the basis of previous hospital admissions: a retrospective observational cohort study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934406/ https://www.ncbi.nlm.nih.gov/pubmed/33733245 http://dx.doi.org/10.1016/S2666-7568(21)00004-0 |
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