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Clinical utility of scores on the Blaylock Risk Assessment Screen (BRASS): An analysis of administrative data
Marilyn J Hodgins1, Susan M Logan2, Jacqueline M Fraser3
1Faculty of Nursing, University of New Brunswick Fredericton, 208 MacLaggan Hall, 33 Dineen Drive, Fredericton, New Brunswick E3B 5A3, Canada.
Insights
The Blaylock Risk Assessment Screen (BRASS) shows high specificity for identifying patients at risk of discharge complications. However, its low sensitivity and positive predictive value suggest limitations in accurately predicting readmissions.
Area of Science:
- Healthcare management
- Patient safety
- Clinical assessment tools
Background:
- Effective discharge planning is crucial for preventing readmissions.
- Identifying high-risk patients is a prerequisite for implementing preventive measures.
- Hospital readmissions pose a significant challenge to healthcare systems.
Purpose of the Study:
- To evaluate the Blaylock Risk Assessment Screen (BRASS) utility.
- To assess BRASS's accuracy in identifying patients with discharge complications.
- To determine BRASS's effectiveness in predicting longer hospital stays or 30-day readmissions.
Main Methods:
- Analysis of 13-months of administrative data from a tertiary care hospital.
- Examination of BRASS sensitivity, specificity, and predictive values.
- Inclusion of hospital discharges to home as the primary outcome.
Main Results:
- 83% of discharges were to home, with a 7% 30-day readmission rate.
- BRASS (score ≥10) demonstrated high specificity for 'ruling in' at-risk patients.
- Low sensitivity and positive predictive value indicated BRASS missed many at-risk patients and misclassified others.
Conclusions:
- BRASS shows promise in identifying patients likely to experience complications (high specificity).
- The tool's low sensitivity and positive predictive value limit its ability to accurately identify all at-risk patients.
- Preventive measures implemented post-BRASS assessment may influence readmission rates, potentially lowering the observed positive predictive value.
Purpose:
Project was undertaken to examine the utility of the Blaylock Risk Assessment Screen (BRASS) in identifying patients who may experience discharge complications as indicated by longer hospital stays or readmission within 30-days of a discharge to home.
Background:
Before measures can be put in place to facilitate discharge planning and to prevent unplanned readmission by recently discharged patients, those at risk of such events must be identified.
Methods:
Project involved an analysis of 13-months of administrative data from one tertiary care hospital. Utility of the BRASS was examined in terms of its sensitivity and specificity as well as its positive and negative predictive values.
Results:
Majority (83%) of hospital discharges were to home. Approximately 7% of patients experienced at least one readmission within 30-days of being discharged to home. Using scores of 10 or higher as an indicator of risk, BRASS exhibited a high degree of specificity suggesting it is useful for 'ruling in' those who have the outcomes-of-interest. However low sensitivity indicates many who experienced the outcomes were incorrectly classified by the BRASS as low risk. The low positive predictive value for 30-day readmission also suggests many who were classified by the BRASS as being 'at risk' were not readmitted.
Conclusion:
The observed rate of 30-day readmission is likely conservative as the analysis involved data from only one acute care facility. One explanation for the low positive predictive value for 30-day readmission is that completion of the BRASS on admission enabled the implementation of preventive measures.
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