Healthcare risk stratification model for emergency departments based on drugs, income and comorbidities : the DICER-score
Ruiz Ramos, Jesús (Institut de Recerca Sant Pau)
Vela, Emili (Institut d'Investigació Biomèdica de Bellvitge)
Monterde, David (Institut d'Investigació Biomèdica de Bellvitge)
Blazquez Andion, Marta (Institut de Recerca Sant Pau)
Puig Campmany, Mireia (Institut de Recerca Sant Pau)
Piera-Jiménez, Jordi (Institut d'Investigació Biomèdica de Bellvitge)
Carot-Sans, Gerard (Institut d'Investigació Biomèdica de Bellvitge)
Juanes-Borrego, Ana (Institut de Recerca Sant Pau)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Background: During the last decade, the progressive increase in age and associated chronic comorbidities and polypharmacy. However, assessments of the risk of emergency department (ED) revisiting published to date often neglect patients' pharmacotherapy plans, thus overseeing the Drug-related problems (DRP) risks associated with the therapy burden. The aim of this study is to develop a predictive model for ED revisit, hospital admission, and mortality based on patient's characteristics and pharmacotherapy. Methods: Retrospective cohort study including adult patients visited in the ED (triage 1, 2, or 3) of multiple hospitals in Catalonia (Spain) during 2019. The primary endpoint was a composite of ED visits, hospital admission, or mortality 30 days after ED discharge. The study population was randomly split into a model development (60%) and validation (40%) datasets. The model included age, sex, income level, comorbidity burden, measured with the Adjusted Morbidity Groups (GMA), and number of medications. Forty-four medication groups, associated with medication-related health problems, were assessed using ATC codes. To assess the performance of the different variables, logistic regression was used to build multivariate models for ED revisits. The models were created using a "stepwise-forward" approach based on the Bayesian Information Criterion (BIC). Area under the curve of the receiving operating characteristics (AUCROC) curve for the primary endpoint was calculated. Results: 851. 649 patients were included; 134. 560 (15. 8%) revisited the ED within 30 days from discharge, 15. 2% were hospitalized and 9. 1% died within 30 days from discharge. Four factors (sex, age, GMA, and income level) and 30 ATC groups were identified as risk factors and combined into a final score. The model showed an AUCROC values of 0. 720 (95%CI:0. 718-0. 721) in the development cohort and 0. 719 (95%CI. 0. 717-0. 721) in the validation cohort. Three risk categories were generated, with the following scores and estimated risks: low risk: 18. 3%; intermediate risk: 40. 0%; and high risk: 62. 6%. Conclusion: The DICER score allows identifying patients at high risk for ED revisit within 30 days based on sociodemographic, clinical, and pharmacotherapeutic characteristics, being a valuable tool to prioritize interventions on discharge.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Elderly ; Emergency care ; Polypharmacy
Publicat a:	BMC Emergency Medicine, Vol. 24 Núm. 1 (december 2024) , p. 23, ISSN 1471-227X

DOI: 10.1186/s12873-024-00946-7
PMID: 38355411

11 p, 1.7 MB

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