Accurate identification of hospital admissions from care homes; development and validation of an automated algorithm. (18th December 2017)

• Record Type: Journal Article
• Authors: Housley, Gemma; Lewis, Sarah; Usman, Adeela; Gordon, Adam L; Shaw, Dominick E
• Is Part Of: Age and ageing. Volume 47:Number 3(2018)
• Page Start: 387
• Page End: 391
• Publication Date: 2017-12-18
• Subjects: care homes -- algorithm -- secondary care -- informatics -- patient admission -- older people; Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afx182
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: measuring the complex needs of care home residents is crucial for resource allocation. Hospital patient administration systems (PAS) may not accurately identify admissions from care homes. Objective: to develop and validate an accurate, practical method of identifying care home resident hospital admission using routinely collected PAS data. Method: admissions data between 2011 and 2012 ( n = 103, 105) to an acute Trust were modelled to develop an automated tool which compared the hospital PAS address details with the Care Quality Commission's (CQC) database, producing a likelihood of care home residency. This tool and the Nuffield method (CQC postcode match only) were validated against a manual check of a random sample of admissions ( n = 2, 000). A dataset from a separate Trust was analysed to assess generalisability. Results: the hospital PAS was inaccurate; none of the admissions from a care home identified on manual check had a care home source of admission recorded on the PAS. Both methods performed well; the automated tool had a higher positive predictive value than the Nuffield method (100% 95% confidence interval (CI) 98.23–100% versus 87.10% 95%CI 82.28–91.00%), meaning those coded as care home residents were more likely to actually be from a care home. Our automated tool had a high level of agreement 99.2% with the second Trust's data (Kappa 0.86 P < 0.001). Conclusions: care home status is not routinely or accurately captured. Automated matching offers an accurate, repeatable, scalable method to identify care home residency and could be used as a tool to benchmark how care home residents use acute hospital resources across the National Health Service.