We previously developed and validated a simple clinical tool, known as ER², for use upon arrival at the hospital during an Emergency Department (ED) visit to screen older ED users at risk of adverse events. ER² provides risk stratification on three levels (i.e., low, moderate and high), which predicts prolonged hospital stays, readmissions after ED visits, and in-hospital and long-term mortality. ER² has many criteria (i.e., easy to use, objective, standardized and based on collection of clinical information) required for an efficient and effective risk stratification of unplanned hospital admissions. Therefore, its use in primary care could be helpful for the care continuum. ER² has not yet been used in primary care to identify community-dwelling elders who are at risk for unplanned hospital admission. We hypothesized that ER² and its a priori risk stratification could be associated with incident unplanned, primary care hospital admissions in community-dwelling elders who consult with their general practitioner (GP).

• To examine the association between the a priori risk stratification levels of ER² as performed by a GP during a primary care consultation and incident unplanned hospital admissions in community-dwelling elders

The design is an observational prospective population-based cohort study. 668 participants (mean age 84.7±3.9 years; 64.7% female) were recruited by their GPs during an index primary care visit. The 6-item BGA was performed at baseline assessment to provide an a priori risk stratification on three levels (low, moderate, high).

Incident unplanned hospital admissions were recorded during a 6-month follow-up period. The incidence of unplanned hospital admissions increased with the risk level defined by the 6-item BGA, with the highest prevalence (35.3%) being reported at the high-risk level (P=0.001). The risk for unplanned hospital admissions in the high-risk level was significant (crude Odds Ratio (OR)=5.48, P=0.001 and fully adjusted OR=3.71, P=0.032, crude Hazard ratio (HR)=4.20; P=0.002 and fully adjusted HR=2.81; P=0.035). The Kaplan-Meier distribution of incident unplanned hospital admissions differed significantly between the three risk levels (P-value=0.002). Participants at the high-risk level were more frequently admitted to hospital than those at the low risk level (P=0.001).

Further research is needed to confirm this first result, to allow for recommending this clinical tool as early as possible for preventative or curative action on unplanned hospital admission risk factors.