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27-03-2013 | Article

Simple scoring system predicts preventable hospital readmissions


Free abstract

medwireNews: A simple prediction model is able to identify hospitalized patients who are most at risk for potentially avoidable hospital readmissions, according to a retrospective cohort study.

The system that Brigham and Women's Hospital (Boston, Massachusetts) researchers created, called the HOSPITAL score, provides a practical tool to gauge 30-day potentially avoidable readmission risk in medical patients.

"The use of this simple score before discharge may help target transitional care for patients who might benefit the most and consequently reduce the rate of avoidable readmission," write Jacques Donze and colleagues in JAMA Internal Medicine.

The tool will likely come in handy in the effort to crack down on common and costly hospital readmissions. Based on the Hospital Readmissions Reduction Program in the Affordable Care Act, Medicare is now altering hospital payment reimbursement as part of a new program to ensure care is carried out in a manner that keeps patients healthy after they leave.

Of the 10,731 eligible discharges assessed, 2398 (22.3%) involved subsequent 30-day readmission, of which 879 (8.5% of all the discharges) were deemed as potentially avoidable.

Up to 60% of high-risk patients could be identified up to 2 days before discharge, which allows sufficient time for intervention. The researchers used a prediction score that took into account seven independent factors: 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.

"This easy-to-use model enables physicians to prospectively identify approximately 27% of the patients as high-risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions to patients who might benefit the most," Donze and team conclude.

The number of prior hospitalizations and the length of stay proved to be especially important predictors of potentially avoidable readmission, which may reflect total burden of illness, illness severity, functional status, as well as social environment.

The authors also noted that the HOSPITAL score has "fair discriminatory power and good calibration in identifying the risk of potentially avoidable readmission."

In an accompanying commentary, Eric Marks (Uniformed Services University of the Health Sciences, Bethesda, Maryland) notes the significant "societal and personal costs" produced by hospital readmissions and the "spectrum of criteria" that it is necessary to understand in order to identify specific patients who are at risk.

By Peter Sergo, medwireNews Reporter