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Development of a Multivariable Prediction Model for Risk of Hospitalization With Pressure Injury After Entering Residential Aged Care

  • Tesfahun C. Eshetie
    Correspondence
    Address correspondence to Tesfahun C. Eshetie, PhD, Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia.
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
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  • Max Moldovan
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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  • Gillian E. Caughey
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

    Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
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  • Catherine Lang
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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  • Janet K. Sluggett
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

    Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
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  • Jyoti Khadka
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    Health and Social Care Economics Group, Caring Future Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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  • Craig Whitehead
    Affiliations
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
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  • Maria Crotty
    Affiliations
    College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia

    Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
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  • Megan Corlis
    Affiliations
    UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia

    Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
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  • Renuka Visvanathan
    Affiliations
    National Health and Medical Research Council, Centre of Research Excellence Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, University of Adelaide, Adelaide, SA, Australia

    Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia

    Aged and Extended Care Services, The Queen Elizabeth Hospital and Basil Hetzel Institute for Translational Research, Central Adelaide Local Health Network, SA Health, Adelaide, SA, Australia
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  • Steve Wesselingh
    Affiliations
    South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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  • Maria C. Inacio
    Affiliations
    Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, SA, Australia

    UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Published:January 02, 2023DOI:https://doi.org/10.1016/j.jamda.2022.12.009

      Abstract

      Objectives

      Although largely preventable, pressure injury is a major concern in individuals in permanent residential aged care (PRAC). Our study aimed to identify predictors and develop a prognostic model for risk of hospitalization with pressure injury (PI) using integrated Australian aged and health care data.

      Design

      National retrospective cohort study.

      Setting and Participants

      Individuals ≥65 years old (N = 206,540) who entered 1797 PRAC facilities between January 1, 2009, and December 31, 2016.

      Methods

      PI, ascertained from hospitalization records, within 365 days of PRAC entry was the outcome of interest. Individual, medication, facility, system, and health care–related factors were examined as predictors. Prognostic models were developed using elastic nets penalized regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination out-of-sample.

      Results

      Within 365 days of PRAC entry, 4.3% (n = 8802) of individuals had a hospitalization with PI. The strongest predictors for PI risk include history of PIs [sub-distribution hazard ratio (sHR) 2.41; 95% CI 1.77–3.29]; numbers of prior hospitalizations (having ≥5 hospitalizations, sHR 1.95; 95% CI 1.74–2.19); history of traumatic amputation of toe, ankle, foot and leg (sHR 1.72; 95% CI 1.44–2.05); and history of skin disease (sHR 1.54; 95% CI 1.45–1.65). Lower care needs at PRAC entry with respect to mobility, complex health care, and medication assistance were associated with lower risk of PI. The risk prediction model had an AUC of 0.74 (95% CI 0.72–0.75).

      Conclusions and Implications

      Our prognostic model for risk of hospitalization with PI performed moderately well and can be used by health and aged care providers to implement risk-based prevention plans at PRAC entry.

      Keywords

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