Identifying care-home residents in routine healthcare datasets: a diagnostic test accuracy study of five methods

Burton, J. K. , Marwick, C. A., Galloway, J., Hall, C., Nind, T., Reynish, E. L. and Guthrie, B. (2019) Identifying care-home residents in routine healthcare datasets: a diagnostic test accuracy study of five methods. Age and Ageing, 48(1), pp. 114-121. (doi: 10.1093/ageing/afy137) (PMID:30124764) (PMCID:PMC6322499)

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Background: there is no established method to identify care-home residents in routine healthcare datasets. Methods matching patient’s addresses to known care-home addresses have been proposed in the UK, but few have been formally evaluated. Study design: prospective diagnostic test accuracy study. Methods: four independent samples of 5,000 addresses from Community Health Index (CHI) population registers were sampled for two NHS Scotland Health Boards on 1 April 2017, with one sample of adults aged ≥65 years and one of all residents. To derive the reference standard, all 20,000 addresses were manually adjudicated as ‘care-home address’ or not. The performance of five methods (NHS Scotland assigned CHI Institution Flag, exact address matching, postcode matching, Phonics and Markov) was evaluated compared to the reference standard. Results: the CHI Institution Flag had a high PPV 97–99% in all four test sets, but poorer sensitivity 55–89%. Exact address matching failed in every case. Postcode matching had higher sensitivity than the CHI flag 78–90%, but worse PPV 77–85%. Area under the receiver operating curve values for Phonics and Markov scores were 0.86–0.95 and 0.93–0.98, respectively. Phonics score with cut-off ≥13 had PPV 92–97% with sensitivity 72–87%. Markov PPVs were 90–95% with sensitivity 69–90% with cut-off ≥29.6. Conclusions: more complex address matching methods greatly improve identification compared to the existing NHS Scotland flag or postcode matching, although no method achieved both sensitivity and positive predictive value > 95%. Choice of method and cut-offs will be determined by the specific needs of researchers and practitioners.

Item Type:Articles
Additional Information:The Older Persons Routine Acute Assessment (OPRAA) development and data collection was funded by the Scottish Government Joint Improvement Team, initial data transfer by an NHS Fife Research & Development (RandD) Bursary and analysis by the National Institutes for Health Research Health Services and Delivery Research Programme (NIHR HSandDR 13/54/55). JKB is supported by Alzheimer Scotland and The University of Edinburgh Centre for Cognitive Ageing and Cognitive Epidemiology, part of the cross council Lifelong Health and Wellbeing Initiative (MR/L501530/1). Funding from the Biotechnology and Biological Sciences Research Council and Medical Research Council is gratefully acknowledged.
Glasgow Author(s) Enlighten ID:Burton, Dr Jenni
Authors: Burton, J. K., Marwick, C. A., Galloway, J., Hall, C., Nind, T., Reynish, E. L., and Guthrie, B.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Age and Ageing
Publisher:Oxford University Press
ISSN (Online):1468-2834
Published Online:26 July 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Age and Ageing 48(1): 114-121
Publisher Policy:Reproduced under a Creative Commons License

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