A new population-based risk stratification tool was developed and validated for predicting mortality, hospital admissions and healthcare costs.

A new population-based risk stratification tool was developed and validated for predicting mortality, hospital admissions and healthcare costs.

Rea, Federico;Corrao, Giovanni;Ludergnani, Monica;Cajazzo, Luigi;Merlino, Luca;
journal of clinical epidemiology 2019
222
rea2019ajournal

Abstract

To develop a new population-based risk stratification tool (Chronic Related Score, CReSc) for predicting 5-year mortality and other outcomes.The score included 31 conditions selected from a list of 65 candidates whose weights were assigned according to the Cox model coefficients. The model was built from a sample of 5.4 million National Health Service (NHS) beneficiaries from the Italian Lombardy Region, and applied to the remaining 2.7 million NHS beneficiaries. Predictive performance was assessed by discrimination and calibration. CReSc ability in predicting secondary endpoints (i.e., hospital admissions and healthcare costs) was investigated. Finally, the relationship between CReSc and income was considered.Among individuals aged 50-85 years, CReSc performance showed (i) an area under the receiver operating characteristic curve of 0.730, (ii) an improved reclassification from 44% to 52% with respect to other scores, and (iii) a remarkable calibration. A trend towards increasing rates of all the considered endpoints as CReSc increases was observed. Compared with individuals on low-intermediate income, NHS beneficiaries on high income showed better CReSc profile.We developed a risk stratification tool able to predict mortality, costs and hospital admissions. The application of CReSc may generate clinically and operationally important effects.

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