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26-03-2013 | Internal medicine | Article

Simple model predicts hospital readmission

Abstract

Free abstract

medwireNews: A simple prediction model can identify patients at increased risk for readmission to hospital before they are discharged, potentially highlighting those who need more intensive transitional care, say scientists.

Jaques Donzé (Brigham and Women's Hospital, Boston, Massachusetts, USA) and colleagues say: "This easy-to-use model enables physicians to prospectively identify approximately 27% of… patients as [at] high-risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions to patients who might benefit the most."

For the study, the team examined 10,731 eligible discharges from any medical service between 2009 and 2010 at an academic medical center, using predischarge administrative and clinical data to develop a prediction model for potentially avoidable 30-day hospital readmissions.

The results show that there were 2398 (22.3%) hospital readmissions within 30 days of discharge, of which 879 (8.5% of index discharges or 36.7% of readmissions) were potentially avoidable. The team notes that at least one procedure was performed in 60.5% of index admissions, with an average of 1.8 procedures per admission. The most common were injection or infusion of cancer chemotherapeutics, biopsy, and transfusion.

The researchers identified eight covariates that were significant predictors for potentially avoidable readmission. Excluding congestive heart failure, a seven-factor predictor score was created, termed HOSPITAL: hemoglobin at discharge; discharge from an oncology service; sodium level at discharge; procedure during the index admission; index type of admission; number of admissions during the past 12 months; and length of stay.

Using different weights for each item, the risk for potentially avoidable readmission was stratified as low (5.2% readmission risk), intermediate (9.8% readmission risk), and high (18.7% readmission risk). These stratifications were supported by analysis of a validation set consisting of a randomized third of all patients in the sample.

The number of prior hospitalizations and the length of stay of the index admission were particularly important predictors for readmission.

The team writes in the journal JAMA Internal Medicine: "A plausible explanation is that previous hospitalization may account for the total burden of illness, illness severity, functional status, and/or social environment. Length of stay also represents the severity of illness."

By Liam Davenport, medwireNews Reporter

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