Risk stratification tools to predict future hospital admissions in elderly people. Application, development and implementation in the Valencian healthcare system

Resumen

The scenario in which this thesis is framed is characterized by a population each time living longer and with a percentage of older people being progressively higher. Additionally, the increasing prevalence of chronic diseases (CD) means an important impact on healthcare systems, as they are the main cause of death worldwide and, in many cases, they are associated to dependency situations and long-term care. In order to approach more effectively the conditions associated to ageing and chronicity, care systems should experience a paradigm change in which the patient is placed in the centre of the care relationship. Primary care (PC) services play an indispensable role to encourage these changes in the care culture by introducing improvements in the management, care and referral of elderly patients and/or with CD. However, in order to not overload the daily functions of PC professionals it would be interesting and useful the implementation of support decision making systems related to the management of these patients. Thus, this thesis banks on the potential use of stratification systems in elderly population with CD at PC services. Throughout this doctoral thesis, three independent but interconnected studies have been carried out. They offer a global view of the viability and potential use of stratification tools at PC services aimed to detect patients at risk of future hospital admissions (FHA). Firstly, it was studied the application of two stratification tools originally developed and validated in the United States (Probability of Repeated Admission – Pra – and The Community Assessment Risk Screen – CARS) – in a sample of elderly people from the Valencian Healthcare System (VHS). Secondly, due to the limited results of the previous study, a new stratification model was developed – associated to a predictive mathematical algorithm – based on the own characteristics of the VHS and the elderly population of the Valencia Region. Finally, a practical implementation using population stratification systems is presented aimed to select and include patients with CD in a telemonitoring programme according to their risk of suffering FHA. The thesis concludes with a set of policy recommendation taken from the results obtained in the three studies. These recommendations may be taken into consideration to improve the management of elderly patients with CD at the VHS or other healthcare systems with similar characteristics.