Alberto Pilotto1, Daniele Sancarlo2, Fabio Pellegrini3, Franco Rengo4, Niccolò Marchionni5, Stefano Volpato6, Luigi Ferrucci7. 1. Department of OrthoGeriatrics, Rehabilitation and Stabilization, E.O. Galliera Hospital, Genova 16128, Italy Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 2. Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 3. Unit of Biostatistics, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy. 4. Geriatric Department, Università Federico II, Napoli, Italy. 5. Geriatric Department, Università di Firenze, Florence, Italy. 6. Geriatrics Unit, University of Ferrara, Ferrara, Italy. 7. National Institute on Aging, Baltimore, MD, USA.
Abstract
BACKGROUND: prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation. OBJECTIVE: to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients. DESIGN: prospective multicentre cohort study. SETTING: twenty Geriatrics Units. PARTICIPANTS: patients aged 65 and older consecutively admitted to Geriatrics Units. MEASUREMENT: 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). RESULTS: 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. CONCLUSIONS: the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.
BACKGROUND: prediction of length of stay (LOS) may be useful to optimise care plans to reduce the negative outcomes related to hospitalisation. OBJECTIVE: to evaluate whether the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), may predict LOS in hospitalised older patients. DESIGN: prospective multicentre cohort study. SETTING: twenty Geriatrics Units. PARTICIPANTS: patients aged 65 and older consecutively admitted to Geriatrics Units. MEASUREMENT: 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). RESULTS: 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. CONCLUSIONS: the MPI is an accurate predictor of LOS in older patients hospitalised with the most frequent diseases.
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