Predicting patients with dementia most at risk of needing psychiatric inpatient or enhanced community care using routinely collected clinical data: a retrospective multi-site cohort study

London, Sabine; Chen, Shanquan; Lewis, Jonathan; Wolverson, Emma; Cardinal, Rudolf; Mueller, Christoph; Underwood, Ben

Abstract

BACKGROUND. Dementia is a common and progressive condition whose prevalence is grow-ing worldwide. It is challenging for healthcare systems to provide continuity in clinical ser-vices for all patients from diagnosis to death. AIMS. To test whether patients who are most likely to need enhanced support later in the disease course can be identified at the point of diagnosis, thus allowing the targeted intervention. METHOD. We used clinical information collected routinely in de-identified electronic patient records from two United Kingdom NHS Trusts to identify at diagnosis which patients were at increased risk of needing enhanced care (psychiatric inpatient or intensive (crisis) community care). RESULTS. We examined the records of a total of 27,313 patients with dementia. A minority (< 15%) needed enhanced care. Patients who needed enhanced care differed from those who did not in age, cognitive test scores, and Health of the Nation Outcome Scale scores. Logistic regression discriminated risk with an area under the receiver operating characteristic curve (AUROC) of 0.74 after 1 year and 0.77 after 4 years. We were able to confirm the validity of the approach in two trusts which differed widely in the populations they serve. CONCLUSIONS. It is possible to identify, at the time of diagnosis of dementia, patients most likely to need enhanced care later in the disease course. This permits the development of targeted clinical interventions for this high-risk group.

Citation

London, S., Chen, S., Lewis, J., Wolverson, E., Cardinal, R., Mueller, C., & Underwood, B. (in press). Predicting patients with dementia most at risk of needing psychiatric inpatient or enhanced community care using routinely collected clinical data: a retrospective multi-site cohort study. British Journal of Psychology,

• Journal Article Type: Article
• Acceptance Date: Dec 14, 2023
• Deposit Date: Dec 15, 2023
• Journal: British Journal of Psychology
• Print ISSN: 0007-1269
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Public URL: https://hull-repository.worktribe.com/output/4484120
• Publisher URL: Early view: https://bpspsychub.onlinelibrary.wiley.com/toc/20448295/0/0