{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T01:41:33Z","timestamp":1785462093091,"version":"3.56.0"},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T00:00:00Z","timestamp":1692835200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["PZ00P3_201672"],"award-info":[{"award-number":["PZ00P3_201672"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2023,12]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Drug\u2010related readmissions (DRAs) are defined as rehospitalizations with an adverse drug event as their main or significant contributory cause. DRAs represent a major adverse health burden for older patients. A prediction model which identified older hospitalized patients at high risk of a DRA <1\u2009year was previously developed using the OPERAM trial cohort, a European cluster randomized controlled trial including older hospitalized patients with multimorbidity and polypharmacy. This study has performed external validation and updated the prediction model consequently.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The MedBridge trial cohort (a multicenter cluster randomized crossover trial performed in Sweden) was used as a validation cohort. It consisted of 2516 hospitalized patients aged \u226565\u2009years. Model performance was assessed by: (1) discriminative power, assessed by the C\u2010statistic with a 95% confidence interval (CI); (2) calibration, assessed by visual examination of the calibration plot and use of the Hosmer\u2013Lemeshow goodness\u2010of\u2010fit test; and (3) overall accuracy, assessed by the scaled Brier score. Several updating methods were carried out to improve model performance.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In total, 2516 older patients were included in the validation cohort, of whom 582 (23.1%) experienced a DRA <1\u2009year. In the validation cohort, the original model showed a good overall accuracy (scaled Brier score 0.03), but discrimination was moderate (C\u2010statistic 0.62 [95% CI 0.59\u20130.64]), and calibration showed underestimation of risks. In the final updated model, the predictor \u201ccirrhosis with portal hypertension\u201d was removed and \u201cpolypharmacy\u201d was added. This improved the model's discriminative capability to a C\u2010statistic of 0.64 (95% CI 0.59\u20130.70) and enhanced calibration plots. Overall accuracy remained good.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The updated OPERAM DRA prediction model may be a useful tool in clinical practice to estimate the risk of DRAs in older hospitalized patients subsequent to discharge. Our efforts lay the groundwork for the future development of models with even better performance.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.18575","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T06:39:23Z","timestamp":1692859163000},"page":"3848-3856","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Drug\u2010related readmissions in older hospitalized adults: External validation and updating of\n OPERAM DRA<\/scp>\n prediction tool"],"prefix":"10.1111","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3605-2289","authenticated-orcid":false,"given":"Birgitta M. G.","family":"Snijders","sequence":"first","affiliation":[{"name":"Department of Geriatrics University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas G. H.","family":"Kempen","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Uppsala University Uppsala Sweden"},{"name":"Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences Utrecht University Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8325-8784","authenticated-orcid":false,"given":"Carole E.","family":"Aubert","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Bern University Hospital, Inselspital University of Bern Bern Switzerland"},{"name":"Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiberdina L.","family":"Koek","sequence":"additional","affiliation":[{"name":"Department of Geriatrics University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivia","family":"Dalleur","sequence":"additional","affiliation":[{"name":"Clinical Pharmacy Research Group, Louvain Drug Research Institute Universit\u00e9 Catholique de Louvain Brussels Belgium"},{"name":"Pharmacy Department Cliniques Universitaires Saint\u2010Luc, Universit\u00e9 Catholique de Louvain Brussels Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Donz\u00e9","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Bern University Hospital, Inselspital University of Bern Bern Switzerland"},{"name":"Department of Internal Medicine Neuchatel Hospital Network Neuch\u00e2tel Switzerland"},{"name":"Division of internal medicine Lausanne University Hospital, CHUV Lausanne Switzerland"},{"name":"Division of General Internal Medicine and Primary Care Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Rodondi","sequence":"additional","affiliation":[{"name":"Department of General Internal Medicine, Bern University Hospital, Inselspital University of Bern Bern Switzerland"},{"name":"Institute of Primary Health Care (BIHAM) University of Bern Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"O'Mahony","sequence":"additional","affiliation":[{"name":"Department of Medicine (Geriatrics) University College Cork Cork Ireland"},{"name":"Department of Geriatric Medicine Cork University Hospital Cork Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrika","family":"Gillespie","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Uppsala University Uppsala Sweden"},{"name":"Hospital Pharmacy Department Uppsala University Uppsala Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilma","family":"Knol","sequence":"additional","affiliation":[{"name":"Department of Geriatrics University Medical Center Utrecht, Utrecht University Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264-021-01144-1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15244"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1585"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.6303"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afaa072"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17667"},{"key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1007\/978-3-030-16399-0","volume-title":"Clinical Prediction Models","author":"Steyerberg 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