Predicting avoidable 30-day readmissions
Boston, MA – In an international, multicenter study researchers have found that the HOSPITAL score, an acronym created to identify the variables associated with hospital readmissions, successfully predicted patients at high risk of a 30-day potentially avoidable readmission. Researchers believe this score may help easily identify patients in need of intense transitional care interventions to prevent avoidable hospital readmissions.
The findings are published in the March 07, 2016 issue of JAMA Internal Medicine.
"Interventions to reduce readmissions are demanding and complex. We need to target patients who are most likely to benefit, which means identifying who is at high risk for avoidable readmission," said Jacques Donzé, MD, MSc, lead author of the study and research associate at Brigham and Women's Hospital (BWH) and Harvard Medical School, and associate physician at the Bern University Hospital (Switzerland). "The three main advantages of this score is that it is simple to use, it can be calculated before discharge so that interventions can be started, and it performs well in many population and countries."
Using data from 117,065 adult patients who were discharged from nine different hospitals across four countries, researchers estimated the risk of 30-day avoidable readmission using the following predictors at discharge: Hemoglobin level, discharge from an Oncology service, Sodium level, Procedure during the index admission, Index Type of admission (urgent), number of Admissions during the last 12 months, and Length of stay. Based on these 7 predictors, each patient obtained a score between 0 and 13, which reflects the risk of readmission. Within 30 days after discharge, 15 percent of the medical patients had a readmission, and 9.7 percent had a potentially avoidable readmission. Using the HOSPITAL score, 62 percent of the patients were categorized as low risk, 24 percent as intermediate risk, and 14 percent as high risk for a potentially avoidable readmission. Patients identified at high risk (7 points or more) had 4 times the risk of being readmitted within 30-days as compared to patients at low risk (4 points or less).
The score showed an excellent ability to identify patients at high risk for potentially avoidable readmission. A 30-day potentially avoidable readmission was predicted with a 72 percent probability using the HOSPITAL score. Moreover, the predicted probabilities of readmission in each risk category matched exactly the real observed proportion of readmission. Overall, patients with a potentially avoidable readmission had an urgent or emergent index admission, were more frequently discharged from an oncology service, had a length of stay greater than 5 days, had more hospitalizations in the past year, were more likely to have had a procedure, and more often had a low hemoglobin or low sodium level at discharge.
"This score is easy to use and is currently the most widely validated prediction model for hospital readmission in medical patients. It remains to be shown whether interventions to reduce readmission are more efficient when targeted specifically to the high-risk patients according to the HOSPITAL score," said Donzé.
This study was funded by the Swiss National Science Foundation and the Swiss Foundation for Medical-Biological Scholarships.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 4.2 million annual patient visits and nearly 46,000 inpatient stays, is the largest birthing center in Massachusetts and employs nearly 16,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication toresearch, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Brigham Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, more than 3,000 researchers, including physician-investigators and renowned biomedical scientists and faculty supported by nearly $666 million in funding. For the last 25 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative as well as the TIMI Study Group, one of the premier cardiovascular clinical trials groups. For more information, resources and to follow us on social media, please visit BWH's online newsroom.