Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review

Abstract

Background: Risk prediction models have been developed to identify those at increased risk for emergency admissions, which could facilitate targeted interventions in primary care to prevent these events.

Objective: Systematic review of validated risk prediction models for predicting emergency hospital admissions in community-dwelling adults.

Methods: A systematic literature review and narrative analysis was conducted. Inclusion criteria were as follows;

Population: community-dwelling adults (aged 18 years and above); Risk: risk prediction models, not contingent on an index hospital admission, with a derivation and ≥1 validation cohort;

Primary outcome: emergency hospital admission (defined as unplanned overnight stay in hospital);

Study design: retrospective or prospective cohort studies.

Results: Of 18,983 records reviewed, 27 unique risk prediction models met the inclusion criteria. Eleven were developed in the United States, 11 in the United Kingdom, 3 in Italy, 1 in Spain, and 1 in Canada. Nine models were derived using self-report data, and the remainder (n=18) used routine administrative or clinical record data. Total study sample sizes ranged from 96 to 4.7 million participants. Predictor variables most frequently included in models were: (1) named medical diagnoses (n=23); (2) age (n=23); (3) prior emergency admission (n=22); and (4) sex (n=18). Eleven models included nonmedical factors, such as functional status and social supports. Regarding predictive accuracy, models developed using administrative or clinical record data tended to perform better than those developed using self-report data (c statistics 0.63-0.83 vs. 0.61-0.74, respectively). Six models reported c statistics of >0.8, indicating good performance. All 6 included variables for prior health care utilization, multimorbidity or polypharmacy, and named medical diagnoses or prescribed medications. Three predicted admissions regarded as being ambulatory care sensitive.

Conclusions: This study suggests that risk models developed using administrative or clinical record data tend to perform better. In applying a risk prediction model to a new population, careful consideration needs to be given to the purpose of its use and local factors.

FIGURE 1

PRISMA flow diagram of included risk prediction models.

FIGURE 2

Methodological quality assessment of included risk prediction models (n=26, n=1, model customized depending on the population it is intended for). A, Derivation studies. B, Validation studies. Colour code: Blue: item done and reported; Red: item not done and reported; Green: item unreported.