A predictive model for identifying patients at risk of delayed transfer of care: a retrospective, cross-sectional study of routinely collected data

Abstract Background Delays to the transfer of care from hospital to other settings represent a significant human and financial cost. This delay occurs when a patient is clinically ready to leave the inpatient setting but is unable to because other necessary care, support or accommodation is unavailable. The aim of this study was to interrogate administrative and clinical data routinely collected when a patient is admitted to hospital following attendance at the emergency department (ED), to identify factors related to delayed transfer of care (DTOC) when the patient is discharged. We then used these factors to develop a predictive model for identifying patients at risk for delayed discharge of care. Objective To identify risk factors related to the delayed transfer of care and develop a prediction model using routinely collected data. Methods This is a single centre, retrospective, cross-sectional study of patients admitted to an English National Health Service university hospital following attendance at the ED between January 2018 and December 2020. Clinical information (e.g. national early warning score (NEWS)), as well as administrative data that had significant associations with admissions that resulted in delayed transfers of care, were used to develop a predictive model using a mixed-effects logistic model. Detailed model diagnostics and statistical significance, including receiver operating characteristic analysis, were performed. Results Three-year (2018–20) data were used; a total of 92 444 admissions (70%) were used for model development and 39 877 (30%) admissions for model validation. Age, gender, ethnicity, NEWS, Glasgow admission prediction score, Index of Multiple Deprivation decile, arrival by ambulance and admission within the last year were found to have a statistically significant association with delayed transfers of care. The proposed eight-variable predictive model showed good discrimination with 79% sensitivity (95% confidence intervals (CIs): 79%, 81%), 69% specificity (95% CI: 68%, 69%) and 70% (95% CIs: 69%, 70%) overall accuracy of identifying patients who experienced a DTOC. Conclusion Several demographic, socio-economic and clinical factors were found to be significantly associated with whether a patient experiences a DTOC or not following an admission via the ED. An eight-variable model has been proposed, which is capable of identifying patients who experience delayed transfers of care with 70% accuracy. The eight-variable predictive tool calculates the probability of a patient experiencing a delayed transfer accurately at the time of admission.

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Drug-related problems in a clinical setting: a literature review and cross-sectional study evaluating factors to identify patients at risk

European Journal of Hospital Pharmacy ◽

10.1136/ejhpharm-2014-000605 ◽

2015 ◽

Vol 22 (4) ◽

pp. 229-235 ◽

Cited By ~ 10

Author(s):

Carli Michèle Wilmer ◽

Victor Johan Bernard Huiskes ◽

Stephanie Natsch ◽

Alexander Johannes Maria Rennings ◽

Bartholomeus Johannnes Frederikus van den Bemt ◽

...

Keyword(s):

At Risk ◽

Literature Review ◽

Clinical Setting ◽

Cross Sectional Study ◽

Drug Related Problems ◽

Sectional Study ◽

Cross Sectional ◽

Patients At Risk

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Advance preferences regarding thrombolysis in patients at risk for stroke: a cross-sectional study: Table 1

QJM ◽

10.1093/qjmed/hcu142 ◽

2014 ◽

Vol 108 (1) ◽

pp. 27-31 ◽

Cited By ~ 1

Author(s):

T. Ó Flatharta ◽

A. Khan ◽

T. Walsh ◽

M. O’Donnell ◽

S.T. O’Keefe

Keyword(s):

At Risk ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Patients At Risk

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Symptom Burden in Patients With Home Care Who Are at Risk for Malnutrition: A Cross-Sectional Study

Journal of Palliative Care ◽

10.1177/0825859719887240 ◽

2019 ◽

Vol 35 (2) ◽

pp. 103-109

Author(s):

Erika Berggren ◽

Peter Strang ◽

Ylva Orrevall ◽

Ann Ödlund Olin ◽

Lena Törnkvist

Keyword(s):

Primary Care ◽

At Risk ◽

Home Care ◽

Older Patients ◽

Symptom Burden ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Significance Level ◽

Patients At Risk

In Sweden, patients in early palliative stages of illness are cared for in primary care and often offered home care. Many are older and at risk for malnutrition, but little is known about their symptom burden and nutritional problems. This cross-sectional study divided older patients in home care into those with and without risk for malnutrition and compared symptom burden in the 2 groups. Participants were patients in Stockholm County (n = 121) in early palliative stages of disease cared for at home by primary care professionals from 10 health-care centers. The Mini Nutritional Assessment (MNA) was used to identify risk for malnutrition. Symptoms and/or nutritional status in patients with and without risk were assessed with the Functional Assessment of Anorexia/Cachexia Therapy (FAACT), Patient-Generated Subjective Global Assessment Short Form (PG-SGA), and Edmonton Symptom Assessment System (ESAS). Forty-two percent of the patients were at risk for malnutrition (MNA). Appetite ( P = .012), tiredness ( P = .003), and anxiety ( P = .008) were worse in these patients than in those without risk (ESAS; significance level, P ≤ .015). Patients at risk were also more concerned about how thin they looked ( P = .006), agreed more strongly that their family or friends were pressuring them to eat ( P = .000; FAACT; significance level, P ≤ .029), had a higher symptom burden ( P = .005), had lower physical activity ( P = .000), and more lost weight over time ( P = .032; PG-SGA; significance level, P ≤ .040). This study adds a more detailed picture of the symptom burden in older patients at risk for malnutrition. Such information is needed to identify risk for malnutrition earlier and improve patients’ health.

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Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients—A Cross-Sectional Study

Journal of Clinical Medicine ◽

10.3390/jcm10112344 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2344

Author(s):

Franca Genest ◽

Dominik Rak ◽

Elisa Bätz ◽

Kerstin Ott ◽

Lothar Seefried

Keyword(s):

At Risk ◽

Risk Groups ◽

Cross Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

Functional Deficits ◽

Complementary Approach ◽

Study Results ◽

Patients At Risk ◽

Not At Risk

Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.

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Screening children at risk for developmental disabilities based on face landmark from video data of mobile-based application: Preliminary Cross-Sectional Study (Preprint)

JMIR Pediatrics and Parenting ◽

10.2196/29908 ◽

2021 ◽

Author(s):

Yu Rang Park ◽

Sang Ho Hwang ◽

Yeonsoo Yu ◽

Jichul Kim ◽

Taeyeop Lee ◽

...

Keyword(s):

At Risk ◽

Developmental Disabilities ◽

Cross Sectional Study ◽

Video Data ◽

Sectional Study ◽

Children At Risk ◽

Cross Sectional

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Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

10.21203/rs.3.rs-24132/v2 ◽

2020 ◽

Author(s):

paula sobral Silva ◽

Sophie Helena Eickmann ◽

Ricardo Arraes de Alencar Ximenes ◽

Ulisses Ramos Montarroyos ◽

Marília de Carvalho Lima ◽

...

Keyword(s):

At Risk ◽

Zika Virus ◽

Cross Sectional Study ◽

Sectional Study ◽

Early Assessment ◽

Cross Sectional ◽

Group 4 ◽

Neurological Abnormalities ◽

Development Delay ◽

And Behavior

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in children with different levels of ZIKV-related microcephaly or with prenatal ZIKV exposure in the absence of microcephaly. Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVxposure confirmed by maternal RT-PCR testing and no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument, and a SWYC adapted form to compare severe cases. Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were at risk of development delay, and presented similar performance whether evaluated under or over 24 months of age. Among children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were at risk of development delay. For children without microcephaly, the percentages found to be at risk of developmental delays were markedly lower and did not differ by prenatal ZIKV exposure status: Groups 3, 13.8%; Group 4, 21.7%. Conclusions: Among groups of children with prenatal ZIKV exposure, we found a gradient of risk of development delay. Children with severe microcephaly were at highest risk, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

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Hawaii's Healthy Start Program of Home Visiting for At-Risk Families: Evaluation of Family Identification, Family Engagement, and Service Delivery

PEDIATRICS ◽

10.1542/peds.105.s2.250 ◽

2000 ◽

Vol 105 (Supplement_2) ◽

pp. 250-259 ◽

Cited By ~ 1

Author(s):

Anne Duggan ◽

Amy Windham ◽

Elizabeth McFarlane ◽

Loretta Fuddy ◽

LCSW, MPH ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Early Identification ◽

Home Visiting ◽

Family Engagement ◽

Cross Sectional Study ◽

Family Characteristics ◽

Sectional Study ◽

Cross Sectional ◽

Healthy Start Program

Objective. To describe family identification, family engagement, and service delivery in a statewide home visiting program for at-risk families of newborns. Setting. Six target communities of Hawaii's Healthy Start Program (HSP), which incorporates 1) early identification of at-risk families of newborns via population-based screening and assessment, and 2) paraprofessionalhome visiting to improve family functioning, promote child health and development, and prevent child maltreatment. Design. Cross-sectional study: describes early identification process and family characteristics associated with initial enrollment. Longitudinal study: describes home visiting process and characteristics associated with continued participation. Subjects. Cross-sectional study: civilian births in 6 communities (n = 6553). Longitudinal study: at-risk families in the intervention group of a randomized trial of the HSP (n = 373). Measures. Process: completeness and timeliness of early identification and home visiting activities; family characteristics: sociodemographics, child abuse risk factors, infant biologic risk. Results. Early identification staff determined risk status for 84% of target families. Families with higher risk scores, young mothers with limited schooling, and families with infants at biologic risk were more likely to enroll in home visiting. Half of those who enrolled were active at 1 year with an average of 22 visits. Families where the father had multiple risk factors and where the mother was substance abusing were more likely to have ≥12 visits; mothers who were unilaterally violent toward the father were less likely. Most families were linked with a medical home; linkage rates for other community resources varied widely by type of service. Half of families overall, but ≥80% of those active at 1 year, received core home visiting services. Performance varied by program site. Conclusions. It is challenging to engage and retain at-risk families in home visiting. Service monitoring must be an integral part of operations.

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