The Risk Instrument for Screening in the Community (RISC): a new instrument for predicting risk of adverse outcomes in community dwelling older adults

BMC Geriatrics

D. William Molloy¹  Nicola Cornally⁴  Patricia Leahy-Warren⁴  Elizabeth Weathers⁴  Carol Fitzgerald⁷  Eileen O’Herlihy⁷  Estera Igras⁷  Una Cronin⁷  Gabrielle O’Keeffe²  Elizabeth O’Connell⁸  Elizabeth Healy⁶  Anton Svendrovski⁵  Yang Gao⁷  Rónán O’Caoimh³ 

[1] COLLAGE (COLLaboration on AGEing), Cork City and Louth Age Friendly County Initiative, Co Louth, University College Cork, Cork, Ireland;Health Service Executive of Ireland, South Lee, St Finbarrs Hospital, Douglas Rd, Cork City, Ireland;Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland;School of Nursing and Midwifery, University College Cork, Cork, Ireland;UZIK Consulting Inc., 86 Gerrard St E, Unit 12D, Toronto M5B 2 J1, ON, Canada;Centre for Public Health Nursing, Ballincollig and Bishopstown, Co, Cork, Ireland;Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Rd, CorkCity, Ireland;Centre for Public Health Nursing, Mahon and Ballintemple, Cork City, Ireland

关键词: and public health nurses (PHNs);    Clinical Frailty Scale (CFS);    Risk Instrument for Screening in the Community (RISC);    Adverse outcomes;    Risk;    Frailty;    Screening;   

Others  :  1221657
DOI  :  10.1186/s12877-015-0095-z

 received in 2014-11-26, accepted in 2015-07-22,  发布年份 2015

【 摘 要 】

Background

Predicting risk of adverse healthcare outcomes, among community dwelling older adults, is difficult. The Risk Instrument for Screening in the Community (RISC) is a short (2–5 min), global subjective assessment of risk created to identify patients’ 1-year risk of three outcomes:institutionalisation, hospitalisation and death.

Methods

We compared the accuracy and predictive ability of the RISC, scored by Public Health Nurses (PHN), to the Clinical Frailty Scale (CFS) in a prospective cohort study of community dwelling older adults (n = 803), in two Irish PHN sectors. The area under the curve (AUC), from receiver operating characteristic curves and binary logistic regression models, with odds ratios (OR), compared the discriminatory characteristics of the RISC and CFS.

Results

Follow-up data were available for 801 patients. The 1-year incidence of institutionalisation, hospitalisation and death were 10.2, 17.7 and 15.6 % respectively. Patients scored maximum-risk (RISC score 3,4 or 5/5) at baseline had a significantly greater rate of institutionalisation (31.3 and 7.1 %, p < 0.001), hospitalisation (25.4 and 13.2 %, p < 0.001) and death (33.5 and 10.8 %, p < 0.001), than those scored minimum-risk (score 1 or 2/5). The RISC had comparable accuracy for 1-year risk of institutionalisation (AUC of 0.70 versus 0.63), hospitalisation (AUC 0.61 versus 0.55), and death (AUC 0.70 versus 0.67), to the CFS. The RISC significantly added to the predictive accuracy of the regression model for institutionalisation (OR 1.43, p = 0.01), hospitalisation (OR 1.28, p = 0.01), and death (OR 1.58, p = 0.001).

Conclusion

Follow-up outcomes matched well with baseline risk. The RISC, a short global subjective assessment, demonstrated satisfactory validity compared with the CFS.

【 授权许可】

   
2015 O'Caoimh et al.

【 图 表 】

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Figure 2.

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