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The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study.

ABSTRACT: prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation.to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients.prospective multicentre cohort study.twenty Geriatrics Units.patients aged 65 and older consecutively admitted to Geriatrics Units.at admission, the CGA-based MPI was calculated by using a validated algorithm that included information on basal and instrumental activities of daily living, cognitive status, nutritional status, the risk of pressures sores, co-morbidity, number of drugs and co-habitation status. According to validated cut-offs, subjects were divided into three groups of risk, i.e. MPI-1 low risk (value ?0.33), MPI-2 moderate risk (value 0.34-0.66) and MPI-3 severe risk of mortality (value ?0.67).two thousand and thirty-three patients were included; 1,159 were women (57.0%). Age- and sex-adjusted mean LOS in patients divided according to the MPI grade was MPI-1 = 10.1 (95% CI 8.6-11.8), MPI-2 = 12.47 (95% CI 10.7-14.68) and MPI-3 = 13.41 (95% CI 11.5-15.7) days (P for trend <0.001). The overall accuracy of the MPI to predict LOS was good (C-statistic 0.74, 95% CI 0.72-0.76). Moreover, a statistically significant trend of LOS means was found even in patients stratified according to their International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) main diagnosis.the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.

SUBMITTER: Pilotto A

PROVIDER: S-EPMC4711657 | biostudies-other | 2016 Jan

REPOSITORIES: biostudies-other

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The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study.

Pilotto Alberto A Sancarlo Daniele D Pellegrini Fabio F Rengo Franco F Marchionni Niccolò N Volpato Stefano S Ferrucci Luigi L

Age and ageing 20160101 1

<h4>Background</h4>prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation.<h4>Objective</h4>to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients.<h4>Design</h4>prospective multicentre cohort study.<h4>Setting</h4>twenty Geriatrics Units.<h4>Participants</h4>patients aged 65 and older consecutively admitted to G ...[more]

PMID: 26764398

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Project description:ObjectivesTo determine whether stroke patients' acute hospital length of stay (AHLOS) varies between hospitals, over and above case mix differences and to investigate the hospital-level explanatory factors.DesignA multicentre prospective cohort study.SettingEight National Health Service acute hospital trusts within the Anglia Stroke & Heart Clinical Network in the East of England, UK.ParticipantsThe study sample was systematically selected to include all consecutive patients admitted within a month to any of the eight hospitals, diagnosed with stroke by an accredited stroke physician every third month between October 2009 and September 2011.Primary and secondary outcome measuresAHLOS was defined as the number of days between date of hospital admission and discharge or death, whichever came first. We used a multiple linear regression model to investigate the association between hospital (as a fixed-effect) and AHLOS, adjusting for several important patient covariates, such as age, sex, stroke type, modified Rankin Scale score (mRS), comorbidities and inpatient complications. Exploratory data analysis was used to examine the hospital-level characteristics which may contribute to variance between hospitals. These included hospital type, stroke monthly case volume, service provisions (ie, onsite rehabilitation) and staffing levels.ResultsA total of 2233 stroke admissions (52% female, median age (IQR) 79 (70 to 86) years, 83% ischaemic stroke) were included. The overall median AHLOS (IQR) was 9 (4 to 21) days. After adjusting for patient covariates, AHLOS still differed significantly between hospitals (p<0.001). Furthermore, hospitals with the longest adjusted AHLOS's had predominantly smaller stroke volumes.ConclusionsWe have clearly demonstrated that AHLOS varies between different hospitals, and that the most important patient-level explanatory variables are discharge mRS, dementia and inpatient complications. We highlight the potential importance of stroke volume in influencing these differences but cannot discount the potential effect of unmeasured confounders.

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The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study.

Publications

The Multidimensional Prognostic Index predicts in-hospital length of stay in older patients: a multicentre prospective study.

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