Table 1 Comparison of the derivation and validation cohorts across all baseline variables under consideration from the RAI-HC

Age (years)

 18–64

18.1 (5,335)

18.5 (1,8810)

0.7131

 65–74

17.8 (5,252)

17.4 (1,705)

 75–84

33.3 (9,824)

33.5 (3,276)

 85 + 

30.8 (9,086)

30.7 (3,004)

Sex

 Male

37.5 (11,070)

38.2 (3,741)

0.2402

 Female

62.5 (18,427)

61.8 (6,054)

Marital status

 Never married

7.7 (2,262)

7.7 (751)

0.9940

 Married

38.8 (11,436)

38.7 (3,789)

 Widowed

36.2 (10,666)

36.3 (3,559)

 Separated/divorced

10.5 (3,093)

10.5 (1,030)

 Unknown

6.9 (2,040)

6.8 (666)

Who lived with at time of referral

 Alone

38.6 (11,388)

38.7 (3,791)

0.1707

 Spouse only

31.3 (9,243)

31.7 (3,104)

 Spouse and others

8.1 (2,374)

7.4 (728)

 Child

11.2 (3,316)

11.1 (1,085)

 Others (not spouse or child)

6.3 (1,857)

6.3 (616)

 Group setting

3.8 (1,126)

3.9 (386)

 Missing

0.7 (193)

0.9 (85)

Province/territory

 Ontario

76.6 (22,607)

75.7 (7,419)

0.0216

 British Columbia

13.3 (3,390)

13.5 (1,3200

 Alberta

4.0 (1,189)

4.1 (403)

 Manitoba

3.5 (1,025)

3.7 (364)

 Newfoundland and Labrador

2.5 (741)

2.9 (282)

 Yukon Territory

0.02 (5)

0.01 (7)

Year of intake assessment

 2010

17.5 (5,177)

17.7 (1,738)

0.1738

 2011

15.9 (4,685)

15.2 (1,484)

 2012

12.7 (3,754)

12.7 (1,241)

 2013

10.1 (2,979)

10.2 (1,000)

 2014

11.0 (3,243)

10.7 (1,052)

 2015

11.8 (3,475)

12.8 (1,251)

 2016

11.7 (3,440)

11.3 (11,05)

 2017

9.3 (2,744)

9.4 (924)

Baseline CPS score

 0

60.8 (17,938)

61.3 (6,003)

0.4054

 1

39.2 (11,559)

38.7 (3,792)

Health Index Scales

 Activities of Daily Living (ADL) Self-Performance Hierarchy Scale

  None/minor difficulty (0–1)

74.4 (21,956)

74.7 (7,314)

0.6424

  Moderate/major difficulty (2–6)

25.6 (7,541)

25.3 (2,481)

 Instrumental Activities of Daily Living (IADL) Involvement Scale

  None/minor difficulty (0–13)

71.5 (21,085)

72.1 (7,066)

0.2113

  Moderate/major difficulty (14–21)

28.5 (8,412)

27.9 (2,729)

 Depression Rating Scale (DRS)

  No signs/symptoms (0–2)

81.0 (23,881)

80.2 (7,851)

0.0789

  Signs/symptoms of depression (3–14)

19.0 (5,616)

19.8 (1,944)

 Pain Scale

  No pain/less than daily pain (0–2)

81.2 (23,957)

80.9 (7,925)

0.4971

  Severe/daily pain (3–4)

18.8 (5,540)

19.1 (18,70)

 Change in Health, End-stage disease Signs and Symptoms Scale (CHESS)

  None/mild health instability (0–1)

52.9 (15,617)

53.0 (5,189)

0.9566

  Moderate/severe health instability (2–5)

47.1 (13,880)

47.0 (4,606)

 Pressure Ulcer Risk Scale (PURS)

  Low risk

86.9 (25,642)

86.6 (8,482)

0.6951

  Moderate risk

8.8 (2,590)

9.1 (893)

  High risk

4.0 (1,188)

4.1 (398)

  Very high risk

0.3 (77)

0.2 (22)

Caregiver status

 Caregiver lives with client

   No

46.8 (13,800)

46.7 (4,575)

0.9235

   Yes

49.6 (14,642)

49.8 (4,877)

   No caregiver

3.6 (1,055)

3.5 (343)

 Caregiver relationship to client

   Child

46.5 (13,715)

46.6 (4,562)

0.9293

   Spouse

30.7 (9,058)

30.9 (3,025)

   Other relative/friend/neighbor

18.9 (5,576)

18.8 (1,839)

   No caregiver

3.6 (1,055)

3.5 (343)

   Missing

0.3 (93)

0.3 (26)

 Caregiver Risk Evaluation (CaRE)

   Low risk

25.4 (7,497)

256.2 (2,568)

0.4534

   Moderate risk

33.3 (9,832)

33.1 (3,241)

   High risk

37.3 (10,991)

36.8 (3,607)

   Very high risk^a

n/a

n/a

   Missing

4.0 (1,177)

3.9 (379)

 Client openly expresses conflict or anger with family/friends

   No

86.1 (25,401)

86.0 (8,421)

0.7261

   Yes

13.9 (4,096)

14.0 (1,374)

Disease diagnoses (reference = not present)

 Stroke

12.7 (3,740)

13.0 (1,269)

0.4774

 Congestive heart failure

12.0 (3,546)

12.4 (1,217)

0.2895

 Coronary artery disease

21.1 (6,215)

20.5 (2,010)

0.2470

 Alzheimer’s dementia

0.9 (272)

0.8 (74)

0.1261

 Dementia (not Alzheimer’s dementia)

3.4 (998)

3.1 (301)

0.1366

 Hemiplegia/hemiparesis

2.2 (641)

2.2 (217)

0.8039

 Multiple sclerosis

1.4 (426)

1.4 (139)

0.8564

 Parkinson’s disease

4.3 (1,261)

4.3 (421)

0.9220

 Any psychiatric diagnosis

14.1 (4,171)

14.5 (1,423)

0.3418

 Hip fracture

3.9 (1,152)

4.0 (395)

0.5749

 Other fracture

8.9 (2,614)

8.8 (866)

0.9502

 Pneumonia

3.0 (895)

3.4 (328)

0.1205

 UTI

5.3 (1,551)

5.4 (529)

0.5851

 Cancer

16.9 (4,981)

17.0 (1,667)

0.7620

 Diabetes

26.9 (7,939)

26.8 (2,622)

0.7779

 Emphysema/COPD/asthma

19.4 (5,718)

19.8 (1,941)

0.3506

 Sudden/new onset change in mental function (last 7 days)

0.9 (250)

0.8)74)

0.3827

Communication and sensory impairments

 Hearing impairment

   No hearing impairment

76.4 (22,523)

77.1 (7,555)

0.1171

   Hearing impairment only

23.6 (6,974)

22.9 (2,240)

 Vision impairment

   No vision impairment

87.5 (25,803)

87.7 (8,587)

0.6211

   Vision impairment only

12.5 (3.694)

12.3 (1,208)

 Dual sensory impairment

   No dual sensory impairment

89.4 (26,371)

89.6 (8,778)

0.5486

   Dual sensory impairment

10.6 (3,126)

10.4 (1,017)

 Ability to understand others

   Understands

91.1 (26,884)

90.8 (8,905)

0.4083

   Usually understands

7.9 (2,343)

8.2 (806)

   Often understands

0.8 (235)

0.8 (77)

   Sometimes understands

0.1 (32)

0.1 (5)

   Rarely/never understands

0.01 (3)

0.02 (2)

Health conditions and behaviours

 Wandering

   No

99.9 (29,455)

99.9 (9,784)

0.4821

   Yes

0.1 (42)

0.1 (11)

 Verbally abusive

   No

98.9 (29,165)

98.8 (9,676)

0.4719

   Yes

1.1 (332)

1.2 (119)

 Physically abusive

   No

99.9 (29,462)

99.9 (9,782)

0.7299

   Yes

0.1 (35)

0.1 (13)

 Socially inappropriate

   No

99.6 (29,388)

99.7 (9,762)

0.6411

   Yes

0.4 (109)

0.3 (33)

 Resists care

   No

98.6 (29,071)

98.3 (9,632)

0.1207

   Yes

1.4 (426)

1.7 (163)

 Chest pain

   No

94.9 (27,980)

95.3 (9,334)

0.0870

   Yes

5.1 (1,517)

4.7 (461)

 No bowel movement in last 3 days

   No

97.8 (11,308)

97.9 (17,557)

0.7834

   Yes

2.2 (251)

2.1 (381)

 Dizziness or light-headedness

   No

75.6 (8,733)

80.0 (14,345)

 < 0.0001

   Yes

24.4 (2,826)

20.0 (3,593)

 Edema

   No

68.0 (20,051)

67.6 (6,623)

0.5082

   Yes

32.0 (9,446)

32.4 (3,172)

 Shortness of breath

   No

69.1 (20,385)

68.9 (6,751)

0.7303

   Yes

30.9 (9,112)

31.1 (3,044)

 Delusions

   No

99.6 (29,375)

99.5 (9,745)

0.2083

   Yes

0.4 (122)

0.5 (50)

 Hallucinations

   No

99.1 (29,234)

99.3 (9,729)

0.0404

   Yes

0.9 (263)

0.7 (66)

 Smoked/chewed tobacco daily

   No

90.4 (26,668)

90.5 (8,866)

0.7564

   Yes

9.6 (2,829)

9.5 (929)

Physical functioning and health status

 Client believes they are capable of increased functional independence

   No

68.4 (20,170)

68.8 (6,739)

0.4376

   Yes

31.6 (9,327)

31.2 (3,056)

 Number of days in the last 7 days client went out of the house

   Every day

13.5 (3,980)

13.7 (1,344)

0.7713

   2–6 days a week

34.3 (10,103)

33.8 (3,314)

   1 day a week

34.2 (10,087)

34.6 (3,387)

   No days

18.1 (5,327)

17.9 (1,750)

 Number of falls in last 90 days

   No falls

56.8 (16,750)

57.0 (5,585)

0.8531

   1 fall

22.9 (6,765)

23.0 (2,249)

   2 or more falls

20.3 (5,982)

20.0 (1,961)

 Unsteady gait

   No

31.2 (9,199)

31.7 (3,105)

0.3423

   Yes

68.8 (20,298)

68.3 (6,690)

 Client limits going outdoors due to fear of falling

   No

51.7 (15,250)

52.2 (5,116)

0.3625

   Yes

48.3 (14,247)

47.8 (4,679)

 Bladder incontinence in last 7 days

   Continent

59.3 (17,480)

59.8 (5,856)

0.3590

  Incontinent

40.7 (12,017)

40.2 (3,939)

 Client believes he/she has poor health

   No

72.9 (21,502)

73.1 (7,163)

0.6520

   Yes

27.1 (7,995)

26.9 (2,632)

 Client has conditions or diseases that make cognition, ADL, mood or behavior patterns unstable

   No

64.5 (19,034)

64.1 (6,278)

0.4362

   Yes

35.5 (10,463)

35.9 (3,517)

 Client experienced a flare-up of a recurrent/chronic problem

   No

84.7 (24,978)

84.4 (8,270)

0.5540

   Yes

15.3 (4,519)

15.6 (1,525)

 Client has a prognosis of less than six months to live

   No

98.5 (29,051)

98.4 (9,640)

0.622

   Yes

1.5 (446)

1.6 (155)

 Number of medications

   0–4

18.3 (5,393)

18.5 (1,808)

0.6978

   5 + 

81.7 (24,104)

81.5 (7,987)

 Swallowing

   Normal

93.0 (274,435)

92.8 (9,091)

0.5095

   Requires modifications to swallow (e.g., diet, tube feeding, etc.)

7.0 (2,062)

7.2 (704)

 Ate one or fewer meals a day in last 3 days

   No

95.5 (28,167)

95.6 (9,365)

0.6220

   Yes

4.5 (1,330)

4.4 (430)

 Unintended weight loss of 5% or more in last 30 days

   No

87.3 (25,756)

87.1 (8,535)

0.6142

   Yes

12.7 (3,741)

12.9 (1,260)

Service utilization

 Hospital admissions (last 90 days)

  0

54.0 (15,913)

53.8 (5,268)

0.8942

  1

38.5 (11,358)

38.8 (3,796)

  2 or more

7.5 (2,226)

7.5 (731)

 Emergency department visits (last 90 days)

   0

72.8 (21,459)

72.8 (7,132)

0.7998

  1

19.2 (5,663)

19.3 (1,894)

   2 or more

8.0 (2,375)

7.9 (769)

 Made economic trade-offs during the last month

   No

96.9 (28,591)

97.1 (9,512)

0.3616

   Yes

3.1 (906)

2.9 (283)

Social functioning

 Client indicates that he/she feels lonely

  No

84.1 (24,812)

83.6 (8,191)

0.2492

  Yes

15.9 (4,685)

16.4 (1,604)

 Change in social activities in last 90 days

   No decline/decline, not distressed

79.3 (23,377)

78.5 (7,693)

0.1333

   Decline, distressed

20.7 (6,120)

21.5 (2,102)