A Probability of Repeated Admission (Pra) score greater than 0.5 predicts hospital admission for older adults living in the community

Wallace E, Hinchey T, Borislaw D, et al. A systematic review of the probability of repeated admission score in community-dwelling adults. J Am Geriat Soc. 2013;61:357-64

Review question

How useful is the Probability of Repeated Admission score to predict hospital admission of older adults living in the community?

Background

Hospital admissions are major health events in a person’s life and also a large share of health care expenses. Early identification of people with high risk for future admissions will help to prepare better for care.

The Probability of Repeated Admission (or Pra) score identifies older adults who are more likely to need hospital admission.

Pra scores go from 0 to 1. A score of 0.5 means a 50% likelihood of 2 or more admissions within the following 4-year period.

The risk factors for repeated admission are 8: older age, male sex, poor self-rated general health, unavailability of an informal caregiver, having ever had heart disease, and having had, during the previous year, a hospital admission, more than 6 doctor visits, or diabetes.

How the review was done

This summary is based on a review of 9 studies on the usefulness of the Pra score to predict hospital admissions. The period included was 1990-2012.

Studies included 36,140 people 65 and older.

The primary outcome of all the studies was hospital admissions. Secondary outcomes included mortality, hospital days, decline in function, other service use, and costs.

What the researchers found

Older adults classified as high risk were more likely to have a hospital admission in the following year. They also had more admissions later.

Pra scores clearly distinguished those who had been admitted to the hospital from those who had not.

Secondary outcomes (mortality, hospital days, decline in function, other health service use, and costs) were difficult to compare across studies. But the Pra score could also predict who would have higher future health care use and costs.

Conclusion

The Pra score is useful to identify older adults living in the community with a high risk of hospital admission.

Probability of repeated admission assessment