Identifying patients at risk of nursing home admission: The Leeds Elderly Assessment Dependency Screening tool (LEADS)

Items from the 3 scales were combined and analysed using Rasch Analysis. Sensitivity and specificity analysis and ROC curves were applied to identify the most appropriate cut score. Binary logistic regression using this cut-off, and other predictive variables, were used to create a predictive algorithm score. Sensitivity, specificity and likelihood ratio scores of the algorithm scores were used to identify the best predictive score for risk of nursing home placement.A 17-item (LEADS) scale was derived, which together with four other indicators, had a sensitivity of 88% for patients at risk of nursing home placement, and a specificity of 85% for not needing a nursing home placement, within 2 weeks of admission.A combined short 17-item scale of dependency plus other predictive variables can assess the risk of nursing home placement for older people in an acute care setting within 2 weeks of admission. This gives an opportunity for either early discharge planning, or therapeutic intervention to offset the risk of placement.The National Service Framework for older people within the UK highlighted the need for a single assessment process to determine the most appropriate setting for ongoing care [1]. To date, professionals are often faced with a large assortment of scales to choose from, identifying measures to aid them in this decision was seen as a priority. As the setting of care is largely determined by the extent of dependency and, for example nursing needs, then clearly measures of dependency will be important in this process. A previous study examined the use of 7 outcome scales and other predictive factors (e.g. presence of pressure sores) in order to identify which scales were predictive of outcome when the patient had recently entered an acute hospital setting[2]. Out of the 7 scales examined only four scales, The Modified Barthel Index (MBI) the Abbreviated Mental Test (AMTS), the Northwick Park Dependency Scale (NPDS), and the Caregiver Strain Index (CSI) wer