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, Sabina; Chen, Shanquan; Sidhom, Emad; Lewis, Jonathan; Wolverson, Emma; Cardinal, Rudolf; Roalf, David; Mueller, Christoph; Underwood, Benjamin

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 (16% in Cambridgeshire and 2.4% in London) 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 char-acteristic curve (AUROC) of up to 0.78 after 1 year and 0.74 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, pa-tients most likely to need enhanced care later in the disease course. This permits the devel-opment of targeted clinical interventions for this high-risk group.

Citation

London, S., Chen, S., Sidhom, E., Lewis, J., Wolverson, E., Cardinal, R., …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 Psychiatry, https://doi.org/10.1192/bjp.2024.14

• Journal Article Type: Article
• Acceptance Date: Mar 29, 2024
• Online Publication Date: May 13, 2024
• Deposit Date: Apr 5, 2024
• Publicly Available Date: Nov 14, 2024
• Journal: British Journal of Psychiatry
• Print ISSN: 0007-1250
• Publisher: Royal College of Psychiatrists
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1192/bjp.2024.14
• Keywords: Dementias/neurodegenerative diseases; Mental health services; Epidemiology; Clinical interventions; Intensive support
• Public URL: https://hull-repository.worktribe.com/output/4619066