Bedside Application of Big Data - Can the Hospital Admission Risk Reduction Program for the Elderly (HARRPE) score identify High Risk Elderly for Advance Care Planning ?

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Authors (including presenting author) :
Chan K(1),Po MYY(1),Sung WLR(1),Ho SKS(1) Mak PK (1) Wong CK(1) Tsui E (2), Kng C(1)
Affiliation :
(1) Community Geriatrics Assessment Service, HKEC and Division of Geriatrics, RTSKH (2) HAHO Statistics Department
Introduction :
HARPPE readmission risk score(a) developed by HAHO Statistics department is a proven instrumental tool applied daily in identifying high risk elderly for Integrated Care and Discharge Service and Patient Support Call Centre. Based on 14 patient medical, socio-demographic and hospital utilisation variables, it is automated, consistently defined and applied across all public hospitals. Clinical observation noted that high HARPPE scores correlated with mortality. We examined if HARRPE score could aid prognostication in frail elderly from Residential Care Homes of the Elderly (RCHE) for timely advance care planning (ACP).
Objectives :
To correlate HARRPE scores with mortality and test feasibility of facilitating case identification for ACP and CGAS End of Life (EOL) Program.
Methodology :
Prospective registry of all HKEC Community Geriatrics Assessment Service (CGAS) cases aged 65 or above acutely admitted with admission HARRPE score >0.4 in April 2018 was kept and followed up for six months. CGAS nurses screened suitability for ACP and EOL program using defined clinical criteria through electronic notes review and communication with RCHE staff.
Result & Outcome :
Overall 47 (49%) of 95 RCHE elderly with HARRPE >0.4 died within 6 months. Higher mortality correlated with higher HARRPE with 180 day mortality rates of 67%, 59% and 36% for corresponding scores of >0.6, >0.5-0.6 and >0.4-0.5. Clinical application of HARRPE identified 26 out of 95 (27%) cases who met clinical inclusion criteria for ACP discussion, with 15 of the 26 (58%) cases newly recruited to EOL program. Exclusions included 17 elderly under existing EOL programs (18%), refusals, early deaths and non-CGAT cases. Conclusion HARRPE score not only predicts unplanned readmissions but mortality in elderly. It is automated and accessible at the bedside to stratify heterogeneous needs of complex frail elderly. Thus, it is a feasible aid to clinical judgement for identifying high risk elderly for ACP and appropriate collaborative care. Reference:(a)Tsui E et al Health Informatics J, 2015 Mar;21(1):46-56.

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