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Risk score could help GPs to cut admissions

By Cato Pedder

GPs can accurately identify patients at highest risk of hospital readmission using a newly validated scoring system, a study reports.

The researchers said the new evidence-based algorithm, already in use in several PCTs, could dramatically improve the results of community matron schemes by targeting their efforts at those most at risk.

Dr Rebecca Rosen, fellow in health policy at the King's Fund, which developed the scoring system, said it could be used by PCTs or individual practices to flag up at-risk patients from hospital admissions data.

'It is an important piece of a large jigsaw of different things that need to be in place for active case management to work,' she said.

Evaluations of community matrons schemes have struggled to demonstrate benefits, partly because most have simply targeted those who have previously been admitted frequently – not all of whom will be at high risk in future.

But the Patients at Risk of Re-hospitalisation algorithm uses data from hospital admissions in England to identify factors such as sex, age and clinical condition that narrow the search to those at high-

est readmission risk (see box,


On a 100-point scale, a cut-off score of 50 identified patients who would need readmission over the following 12 months with a sensitivity of 54 per cent and a specificity of 65 per cent – results the researchers described as 'reasonable'.

Using higher cut-offs of 70 or 80 points increased specificity to 77 and 84 per cent but dropped sensitivity down to just 18 and 8 per cent respectively.

Dr Rosen, a GP in Woolwich, south-east London, added: 'We have just started in my

practice and already we have found two or three patients with unmet needs and have quite easily been able to sort them out.'

Dr Rosen said a risk score of 50 should be the 'trigger point' to investigate patients.

Dr Bruce Allan, a GP in Worthing, West Sussex, who has criticised the community matron scheme for creating inappropriate referrals, said the

algorithm could improve matters. 'Tools such as this will help very much in targeting community matrons services at the appropriate population.'

The algorithm, which is described in the BMJ, is freely available via the King's Fund's website at

Who is at risk?

Variables included in algorithm

• Age, sex and ethnicity

• Alcohol-related disorders

• Chronic conditions (including arthritis, COPD, heart disease and stroke)

• Developmental disability

• Number of specialists seen

• Previous admission for a reference condition

• Previous admission for respiratory infection

• Emergency admissions in previous 90, 180 and 365 days

• Non-emergency admissions in previous 365 days

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