Background
Methods
Data
Inclusion criteria
AR DRG codes* |
Description
|
---|---|
B63Z | Dementia and other chronic disturbances of cerebral function |
B67A-B67C | |
B68A-B68B | Multiple sclerosis and other demyelinating disorders |
B76A-B76B | Epilepsy (<69 years or with complications or co-morbidities) |
E60A-E60B | Cystic fibrosis |
E65A-E65B | Chronic obstructive pulmonary disease (includes bronchiectasis) |
E69A-E69B | Asthma (>49 years or with complications or co-morbidities) |
E74A-E74C | Interstitial lung disease |
E75A-E75B | Other respiratory diagnoses (>69 years or with complications or co-morbidities) |
E60A-E75B; (excluding E71A-E71C, lung cancer) | Complex elderly with a respiratory system primary diagnosis (>69 years) |
F62A-F62B | Heart failure |
F65A-F65B | Peripheral vascular disorders (>69 years or with complications or co-morbidities) |
F66A-F66B | Coronary atherosclerosis |
F70A-F71B | Arrhythmia or conduction disorders (>69 years or with complications or co-morbidities) |
F72A-F72B | Angina (>69 years or with complications or co-morbidities) |
F60A-F75C | Complex elderly with a cardiac primary diagnosis (>69 years) |
I65A-I70Z | Inflammatory spine, joint or connective tissue disease |
J60A | Skin ulcers |
K60A-K60B | Diabetes (>69 years or with complications or co-morbidities) |
K01Z | Diabetic foot procedures |
K61Z-K64B | Complex elderly with endocrine or metabolic system primary diagnosis (>69 years) |
L63A-L63B | Kidney or urinary tract infections (>69 years or with complications or co-morbidities) |
Q61A-Q61C | Red blood cell disorders (>69 years or with complications or co-morbidities) |
Q62Z | Coagulation disorders |
Outcome measure
Predictor variables
Demographic measures
Co-morbidities
ICD10-AM | Co-morbidity | ICD10-AM | Co-morbidity |
---|---|---|---|
D5000–D6499 | Anaemia | I2000–I2599 | Acute coronary syndrome |
I4800–I4899 | Cardiac arrhythmias | I5000–I5099 | Heart failure |
I1000–I1599 | Hypertensive diseases | I6000–I6999 | Cerebrovascular diseases |
I7000–I7399 | Peripheral vascular disease | C0000–C9699 | Malignant neoplasms |
J4500–J4699 | Asthma | J4700–J4799 | Bronchiectasis |
J4000–J4499 | COPD including bronchitis and emphysema | G2000–G2299 | Parkinson's disease |
G3000–G3099 F0000–F0399 | Dementias | F1000–F1099 | Mental disorders due to alcohol use |
F1100–F1999 | Mental disorders due to other drug use | E1000–E1499 | Diabetes mellitus |
N1700–N1799 | Acute renal failure | N1800–N1999 | Chronic renal failure |
J1000–J2299 | Lower respiratory tract infections | M0500–M1499 | Inflammatory arthritis |
M3000–M3699 | Systemic connective tissue disorder | F2000–F2999 | Schizophrenic disorders |
F3000–F3999 | Mood (affective) disorders | I0500–I0999 I3300–I3999 | Chronic rheumatic heart disease and other heart valve disorders |
K7000–K7799 | Liver diseases | K8500–K8699 | Pancreatic diseases |
B2000–B2499 | HIV | M8000–M8299 | Osteoporosis |
W0000–W1999 | Falls |
Prior utilisation
Statistical analysis
Predictive algorithm
Performance of algorithm
Results
Full Sample (n = 17,699) | Development sample (n = 13,207) | Validation sample (n = 4,492) | |
---|---|---|---|
% | % | % | |
Twelve month readmission rate | 45.4 | 45.5 | 45.1 |
Age Group | |||
0–17 years | 3.2 | 3.2 | 3.3 |
18–39 years | 8.8 | 8.7 | 9.0 |
40–64 years | 23.7 | 23.8 | 23.4 |
65–74 years | 20.5 | 20.4 | 20.7 |
75+ years | 43.8 | 43.9 | 43.6 |
Sex | |||
Male | 49.3 | 49.4 | 48.9 |
Female | 50.7 | 50.6 | 51.1 |
Marital status | |||
Never married | 20.6 | 20.5 | 20.8 |
Married/de facto | 48.6 | 48.8 | 48.1 |
Widowed | 21.0 | 20.9 | 21.2 |
Separated/divorced | 9.9 | 9.8 | 9.9 |
Indigenous status | |||
Non-Indigenous | 96.0 | 95.9 | 96.1 |
Indigenous | 4.0 | 4.1 | 3.9 |
SEIFA1
| |||
Most disadvantaged | 28.5 | 28.8 | 27.8 |
Quintile 2 | 28.0 | 27.8 | 28.5 |
Quintile 3 | 21.0 | 21.1 | 20.7 |
Quintile 4 | 15.7 | 15.6 | 16.2 |
Least Disadvantaged | 6.7 | 6.7 | 6.8 |
ARIA2
| |||
Major city | 43.7 | 43.3 | 44.8 |
Inner Regional | 28.6 | 28.9 | 27.9 |
Outer Regional | 22.6 | 22.6 | 22.6 |
Remote | 2.7 | 2.8 | 2.4 |
Very Remote | 2.4 | 2.5 | 2.4 |
Predictors included in the algorithm
Parameter | Odds ratio | 95% CI | p-value |
---|---|---|---|
Age Group | |||
0–17 years | 1.00 | - | |
18–39 years | 0.94 | 0.74–1.19 | 0.60 |
40–64 years | 1.09 | 0.88–1.36 | 0.43 |
65–74 years | 1.32 | 1.06–1.65 | 0.02 |
75+ years | 1.30 | 1.05–1.61 | 0.02 |
SEIFA1
| |||
Most disadvantaged | 1.00 | - | |
Quintile 2 | 0.85 | 0.78–0.94 | 0.001 |
Quintile 3 | 0.96 | 0.86–1.06 | 0.39 |
Quintile 4 | 0.79 | 0.71–0.89 | 0.0001 |
Least Disadvantaged | 0.80 | 0.68–0.94 | 0.007 |
ARIA2
| |||
Major city | 1.00 | - | |
Inner Regional | 1.01 | 0.92–1.11 | 0.81 |
Outer Regional | 1.10 | 1.00–1.22 | 0.04 |
Remote | 1.30 | 1.04–1.62 | 0.02 |
Very Remote | 1.36 | 1.08–1.73 | 0.01 |
Co-morbidities | |||
Anaemia | 1.31 | 1.16–1.47 | 0.001 |
Acute coronary syndrome | 1.14 | 1.04–1.25 | 0.005 |
Heart failure | 1.25 | 1.12–1.38 | <0.0001 |
Peripheral vascular disease | 1.32 | 1.10–1.58 | 0.003 |
Malignant neoplasms | 1.29 | 1.10–1.51 | 0.002 |
COPD | 1.21 | 1.10–1.34 | 0.0002 |
Mental disorder (alcohol) | 1.42 | 1.16–1.74 | 0.001 |
Diabetes | 1.27 | 1.16–1.39 | <0.0001 |
Chronic renal failure | 1.30 | 1.12–1.52 | 0.001 |
Mood disorders | 1.22 | 1.00–1.50 | 0.06 |
Liver diseases | 1.45 | 1.06–1.99 | 0.02 |
Any previous admission | |||
Past year | |||
None | 1.00 | - | |
One | 1.14 | 1.01–1.28 | 0.03 |
Two or more | 1.63 | 1.38–1.91 | <0.0001 |
Past 3 years | |||
None | 1.00 | - | |
One | 1.45 | 1.31–1.62 | <0.0001 |
Two or more | 1.74 | 1.53–1.98 | <0.0001 |
Risk score threshold | |||
---|---|---|---|
50% | 70% | 80% | |
Queensland data
| |||
Sensitivity (95% CI) | 44.7 (42.5–46.9) | 7.8 (6.7–9.1) | 1.1 (0.1–1.7) |
Specificity (95% CI) | 78.1 (76.4–79.6) | 97.5 (96.8–98.1) | 99.8 (99.6–99.9) |
False positive rate (95% CI) | 37.5 (35.0–40.0) | 28.2 (22.3–34.6) | 14.8 (4.2–33.7) |
LR+ (95% CI) | 2.04 (1.86–2.23) | 3.11 (2.33–4.15) | 7.02 (2.43–20.28) |
LR- (95% CI) | 0.71 (0.68–0.74) | 0.95 (0.93–0.96) | 0.99 (0.99–1.00) |
UK study[11] | |||
Sensitivity | 54.3 | 17.8 | 8.1 |
Specificity | 72.2 | 95.0 | 98.6 |
False positive rate | 34.7 | 22.6 | 15.7 |
LR+ (95% CI) | 2.0 | 3.6 | 5.8 |
LR- (95% CI) | 0.6 | 0.9 | 0.9 |
US study[14] | |||
Sensitivity | 57.9 | Not reported | Not reported |
Specificity | 70.7 | ||
False positive rate | 34.1 | ||
LR+ (95% CI) | 2.0 | ||
LR- (95% CI) | 0.6 |