Revolving Door in Older Patients: An Observational Study of Risk Assessment of Rehospitalization Using the BRASS Scale

TL;DR

This study shows that the BRASS Scale effectively predicts rehospitalization and mortality risks in older patients after discharge.

Contribution

The study validates the BRASS Scale as a reliable tool for assessing rehospitalization and mortality risks in older adults.

Findings

High-risk patients had significantly higher mortality and lower survival rates.

Intermediate-risk patients had increased rehospitalization rates.

The BRASS Scale showed good predictive value for mortality with an AUC of 0.76.

Abstract

Introduction: The “revolving” door is a phenomenon that refers to the rehospitalization of older patients who, after being discharged, soon require specialized hospital care again. Unfortunately, the use of tools able to predict this phenomenon is still limited. The aim of this study was to highlight the validity of the Blaylock Risk Assessment Screening (BRASS) Scale in objectively assessing the risk of rehospitalization and mortality among older patients. Methods: Patients were classified as low, medium, or high risk using the BRASS scale. Adverse events (rehospitalization or death) were recorded at baseline and at 12 months. Kaplan–Meier curves evaluated survival and rehospitalization across risk groups, and ROC analysis assessed the BRASS Scale’s predictive value for mortality. Results: Out of 179 enrolled older adults (mean age 67.7 years), 54.2% were classified as low risk, 29.5% as medium, and 16.8% as high risk based on the BRASS Scale. High-risk patients had significantly higher mortality (HR: 4.40; 95% CI: 1.60–12.19, p = 0.004) and lower survival rates, while intermediate-risk patients had increased rehospitalization (HR: 2.11; 95% CI: 1.09–4.08, p = 0.02). The BRASS scale showed good predictive value for mortality (AUC 0.76). Conclusion: The BRASS Scale has a good predictive value for negative outcomes, and it confirms that a substantial proportion of older patients are at risk of future hospital readmissions and complex discharges. These findings underscore the importance of early post-discharge care planning and the implementation of protected discharge programs.

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