Pattern · VF-P4 · On the register since June 2026
Acute-designed shortcuts carry material risk in community settings
Risk scores calibrated in hospital discriminate poorly or overestimate risk when used in home-based acute care (NEWS2 on virtual wards; Padua and IMPROVE in hospital at home). Whether this harms patients is not measured.
Register's basis, before re-grading: Confirmed by a single further study this cycle
Status now
Provisional
Every pattern enters here, never higher. Its first entry names what evidence would qualify, contest or discard it. The publication's own inferences stay here until external evidence or events move them.
Entered the register as established in June 2026, before the promotion tests existed. They were not applied on entry.
How we grade →Path through the register
Holds across
- D01 Acute Frailty
- D02 Clinical Psychology (not spanned)
- D03 Palliative Care (not spanned)
- D04 Therapies & AHPs
- D05 OPAT
How it grades
The register recorded this pattern as established. Graded against the written rules, it is provisional. The register moves at its next monthly review.
- The claim the evidence supports
- Risk scores calibrated in hospital discriminate poorly or overestimate risk when used in home-based acute care (NEWS2 on virtual wards; Padua and IMPROVE in hospital at home). Whether this harms patients is not measured.
- Starting point
- The evidence
- 3 test or bear on it 1 cited but do not test it 0 not yet read at source 0 endorsements, not counted Domains earned: D01, D05 of the 3 it spans
- What would prove it wrong
- A prospective comparison at home showing a hospital-designed score or device performing at ward-level accuracy.
- What the re-grade found
- The wearable study was described as 'ward-validated', but the device underperformed on the ward too (oxygen data 48% complete against 84%). No source measures harm. On the grade: disagreed: one pass would qualify it on the narrower claim (moderate); reconciled to the more cautious grade, because both read the same two cohorts.
A grade measures how certain the evidence we have assessed makes the claim as worded: its own sources and the settled evidence for its domains. Low means unproven, not implausible. What a grade means →
How we grade →The longitudinal record
- Established
Entered the register
NEWS2 AUC 0.55 in OPAT setting (PMID 42048369); ceftriaxone OR 3.33 for 30-day mortality in MSSA-BSI vs antistaphylococcal penicillins (11 studies, n=2,568; PMID 42112603); TROMBODOM VTE risk overestimation in Hospital at Home (46–75% vs actual 1.2% incidence; PMID 42002440). No new evidence in June 2026 invocation.
Recorded before the register required linked evidence: the sources are as named above, with PubMed records linked, and the rest are not individually linked.
- Established
Reconfirmed
Confirmed, single study. A wearable vital-sign monitor that performed on wards lost data at home (oxygen-saturation availability 39%, respiratory-rate availability 46%; n=45, one centre). Disconfirmation condition: a prospective home comparison showing an acute-designed score or device performing at ward-level accuracy.
Evidence PMID 42348131
Cite as: The Value Forge, pattern VF-P4 — “Acute-designed shortcuts carry material risk in community settings”, tracked since 2026-06. CC BY 4.0. Register generated 2026-10-10.