Extension and Validation of the Self-care Index to Predict Transfer to a Post-acute Care Institution in Internal Medicine Patients / Erweiterung und Validierung des Selbstpflegeindexes bei internistischen Patienten mit dem Ziel eine Verlegung in eine post-akute Nachsorgeinstitution vorauszusagen

	Dimension	Additional information
Point value: 1–4 (no ability / severely impaired ability / low impaired ability / full ability)	Movement	Self-care ability activity/movement (e.g., from bed to chair)
	Personal hygiene, upper body	Self-care ability in personal hygiene, upper body
	Personal hygiene, lower body	Self-care ability in personal hygiene, lower body
	Dressing, upper body	Self-care ability in dressing and undressing upper body
	Dressing, lower body	Self-care ability in dressing and undressing lower body
	Feeding, food	Self-care ability ingestion: food
	Feeding, drink	Self-care ability ingestion: drink
	Excretion, urine	Self-care ability urine excretion
	Excretion, stool	Self-care ability stool excretion
	Cognition/consciousness	Ability to acquire knowledge
Scoring (sum of points):	10 (full dependency)	40 (full independency)

[i] Source: Koch et al. 2019, used with permission.

Table 2

Patient characteristics discharged to PAC facility versus home.

	Overall	Discharged to PAC facility	Discharged to home	P-value
	n = 1372	n = 154	n = 1218
Gender^a: female (%) male (%)	571 (41.6%) 801 (58.4%)	93 (60.4%) 61 (39.6%)	478 (39.2%) 740 (60.8%)	<0.001
Age^b: mean (SD); median [IQR]	66.4 (15.9) 69 [57–78]	75.3 (12.3) 77.5 [69–83]	65.3 (16.0) 68 [56–77]	<0.001
SPI first assessment on ward^b: mean (SD); median [IQR]	35.6 (6.0); 38 [34–40]	29.0 (7.5); 30 [25–35]	36.4 (5.2); 38 [35–40]	<0.001
Length of hospital stay^b: mean (SD); median [IQR]	7.7 (7.8); 6 [4–9]	16.8 (12.2); 14 [10–21]	6.6 (6.2); 5 [3–8]	<0.001

a Chi-square tests

b Mann-Whitney U-tests

Table 3

Odds ratios of discharge to a post-acute care institution by individual SPI-items compared to the original evaluation; both models include all individual items.

10 SPI all individual items	Medical inpatients Conca, this study		Mixed population Grosse Schlarmann, 2007
	Odds ratio	Sig.	Odds ratio	Sig.
Activity^*	0.73	0.03	0.40	<0.001
Food intake	0.70	0.17	0.51	0.38
Drink	2.67	0.001	4.32	0.07
Urine^*	0.92	0.53	0.39	0.001
Stool	1.07	0.66	1.38	0.45
Body care, upper body	1.02	0.93	0.78	0.64
Body care, lower body	0.44	0.002	0.23	0.005
Dress/undress upper body	0.88	0.61	0.68	0.48
Dress/undress lower body	0.96	0.89	2.92	0.06
Acquire knowledge	0.57	<0.001	0.95	0.86

* p < 0.05 differences (Chi-square test).

Note: Lower item values mean higher dependence in the respective dimension. Odds ratios < 1 (> 1) stand for a positive (negative) association between discharge to a post-acute care institution and the degree of dependence in the respective item's dimension.

Endpoints; timing and criteria of SPI selection:

Discharge destination post-acute care institution after hospital; first assessment SPI (Conca, this study).

Activities of the case-management by nurses; lowest assessment SPI during hospital stay (Grosse Schlarmann, 2007)

Table 4

Comparison of training and validation measures; Age: centered (65 years).

Model training (t), validation (v)^a n = 814 (t), n = 558 (v)	AUC	AIC	BIC
Total SPI, t	0.824	477.0	486.4
Total SPI, v	0.808	338.9	347.6
Total SPI + age + gender, t	0.836	456.5	475.3
Total SPI + age + gender, v	0.829	321.1	329.8
SPI all individual items, t	0.828	461.6	513.3
SPI all individual items, v	0.814	328.2	336.8
SPI all individual items + age + gender, t	0.848	451.2	512.3
SPI all individual items + age + gender, v	0.837	317.9	326.5

a The analysis in the validation data set involved the score having been derived in the training data set, and thus it only used one degree of freedom.

Abbreviations: AUC, area under curve; AIC, Akaike information criterion; BIC, Bayesian information criterion.

Validation dataset: Score involving all SPI items, age, and gender. Score involving SPI total, age and gender, and original SPI total score.

Table 5

Extended model training data set.

Extended model: SPI all individual items, age, and gender AUC = 0.842	Medical in-patients training dataset (n = 814)
	Coefficients	Sig.
Activity	−0.011	0.957
Body care, upper body	0.046	0.895
Body care, lower body	−0.304	0.429
Dress/undress upper body	−0.099	0.781
Dress/undress lower body	−0.661	0.105
Food intake	−0.496	0.093
Drink intake	0.972	0.005
Urine excretion	−0.229	0.248
Stool excretion	0.044	0.849
Acquire knowledge	−0.537	0.005
Age (centered around 65 years)	0.024	0.013
Gender	0.666	0.010
Constant	−0.577	0.606

References

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Articles in this issue

DOI: https://doi.org/10.2478/ijhp-2022-0005 | Journal eISSN: 2296-990X

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Language: English, German

Page range: 59 - 66

Submitted on: Mar 19, 2022

Accepted on: May 5, 2022

Published on: Jul 13, 2022

Published by: ZHAW Zurich University of Applied Sciences

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Self-care index,

social worker referral,

predictive model,

post-acute care transfer,

screening tool,

discharge destination,

Related subjects:

Clinical medicine, other

© 2022 Antoinette Conca, Daniel Koch, Katharina Regez, Alexander Kutz, Sebastian Haubitz, Philipp Schuetz, Beat Mueller, Christian Schindler, Rebecca Spirig, Heidi Petry, published by ZHAW Zurich University of Applied Sciences
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 9 (2022): Issue 1 (January 2022)

Extension and Validation of the Self-care Index to Predict Transfer to a Post-acute Care Institution in Internal Medicine Patients / Erweiterung und Validierung des Selbstpflegeindexes bei internistischen Patienten mit dem Ziel eine Verlegung in eine post-akute Nachsorgeinstitution vorauszusagen

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Table 4

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