Open Access Research article

Method for Assigning Priority Levels in Acute Care (MAPLe-AC) predicts outcomes of acute hospital care of older persons - a cross-national validation

Anja Noro1*, Jeffrey W Poss2, John P Hirdes23, Harriet Finne-Soveri1, Gunnar Ljunggren45, Jan Björnsson6, Marianne Schroll7 and Palmi V Jonsson89

Author Affiliations

1 Ageing and Services Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271 Helsinki, Finland

2 Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, N2L 3G1, Canada

3 Homewood Research Institute, 150 Delhi Street, Guelph,ON N1E 6K9, Canada

4 Centre for Medical Knowledge, Unit for Analyses and Comparisons, Stockholm County Council, Högbergsgatan 62, Stockholm (118 91), Sweden

5 Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Berzelius Väg 3, Stockholm (17177), Sweden

6 Department of Medicine, Diakonhjemmet Hospital, Pb23 Vinderen, Oslo (0319), Norway

7 Geriatric Department, Bispebjerg Hospital, Copenhagen University, Bispebjerg Bakke 23, Copenhagen (2400), Denmark

8 Faculty of Medicine, University of Iceland, Reykjavik, Iceland

9 Geriatric Department, Landspitali University Hospital, Landakot 101, Reykjavik, Iceland

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BMC Medical Informatics and Decision Making 2011, 11:39  doi:10.1186/1472-6947-11-39

Published: 7 June 2011



Although numerous risk factors for adverse outcomes for older persons after an acute hospital stay have been identified, a decision making tool combining all available information in a clinically meaningful way would be helpful for daily hospital practice. The purpose of this study was to evaluate the ability of the Method for Assigning Priority Levels for Acute Care (MAPLe-AC) to predict adverse outcomes in acute care for older people and to assess its usability as a decision making tool for discharge planning.


Data from a prospective multicenter study in five Nordic acute care hospitals with information from admission to a one year follow-up of older acute care patients were compared with a prospective study of acute care patients from admission to discharge in eight hospitals in Canada. The interRAI Acute Care assessment instrument (v1.1) was used for data collection. Data were collected during the first 24 hours in hospital, including pre-morbid and admission information, and at day 7 or at discharge, whichever came first. Based on this information a crosswalk was developed from the original MAPLe algorithm for home care settings to acute care (MAPLe-AC). The sample included persons 75 years or older who were admitted to acute internal medical services in one hospital in each of the five Nordic countries (n = 763) or to acute hospital care either internal medical or combined medical-surgical services in eight hospitals in Ontario, Canada (n = 393). The outcome measures considered were discharge to home, discharge to institution or death. Outcomes in a 1-year follow-up in the Nordic hospitals were: living at home, living in an institution or death, and survival. Logistic regression with ROC curves and Cox regression analyses were used in the analyses.


Low and mild priority levels of MAPLe-AC predicted discharge home and high and very high priority levels predicted adverse outcome at discharge both in the Nordic and Canadian data sets, and one-year outcomes in the Nordic data set. The predictive accuracy (AUC's) of MAPLe-AC's was higher for discharge outcome than one year outcome, and for discharge home in Canadian hospitals but for adverse outcome in Nordic hospitals. High and very high priority levels in MAPLe-AC were also predictive of days to death adjusted for diagnoses in survival models.


MAPLe-AC is a valid algorithm based on risk factors that predict outcomes of acute hospital care. It could be a helpful tool for early discharge planning although further testing for active use in clinical practice is still needed.