Simplification of the HOSPITAL score for predicting 30-day readmissions.

Aubert, Carole Elodie; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Zimlichman, Eyal; Vasilevskis, Eduard E; Kripalani, Sunil; Metlay, Joshua P; Wallington, Tamara; Fletcher, Grant S; Auerbach, Andrew D; Aujesky, Drahomir; Donzé, Jacques (2017). Simplification of the HOSPITAL score for predicting 30-day readmissions. BMJ Quality and Safety, 26(10), pp. 799-805. BMJ Publ. Group 10.1136/bmjqs-2016-006239

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OBJECTIVE The HOSPITAL score has been widely validated and accurately identifies high-risk patients who may mostly benefit from transition care interventions. Although this score is easy to use, it has the potential to be simplified without impacting its performance. We aimed to validate a simplified version of the HOSPITAL score for predicting patients likely to be readmitted. DESIGN AND SETTING Retrospective study in 9 large hospitals across 4 countries, from January through December 2011. PARTICIPANTS We included all consecutively discharged medical patients. We excluded patients who died before discharge or were transferred to another acute care facility. MEASUREMENTS The primary outcome was any 30-day potentially avoidable readmission. We simplified the score as follows: (1) 'discharge from an oncology division' was replaced by 'cancer diagnosis or discharge from an oncology division'; (2) 'any procedure' was left out; (3) patients were categorised into two risk groups (unlikely and likely to be readmitted). The performance of the simplified HOSPITAL score was evaluated according to its overall accuracy, its discriminatory power and its calibration. RESULTS Thirty-day potentially avoidable readmission rate was 9.7% (n=11 307/117 065 patients discharged). Median of the simplified HOSPITAL score was 3 points (IQR 2-5). Overall accuracy was very good with a Brier score of 0.08 and discriminatory power remained good with a C-statistic of 0.69 (95% CI 0.68 to 0.69). The calibration was excellent when comparing the expected with the observed risk in the two risk categories. CONCLUSIONS The simplified HOSPITAL score has good performance for predicting 30-day readmission. Prognostic accuracy was similar to the original version, while its use is even easier. This simplified score may provide a good alternative to the original score depending on the setting.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine

UniBE Contributor:

Aubert, Carole Elodie; Aujesky, Drahomir and Donzé, Jacques

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2044-5415

Publisher:

BMJ Publ. Group

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

19 Feb 2018 14:49

Last Modified:

19 Feb 2018 14:49

Publisher DOI:

10.1136/bmjqs-2016-006239

PubMed ID:

28416652

Uncontrolled Keywords:

Adverse events, epidemiology and detection Hospital medicine Risk management Transitions in care

URI:

https://boris.unibe.ch/id/eprint/110660

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