Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model

Donzé, Jacques; Aujesky, Drahomir; Williams, Deborah; Schnipper, Jeffrey L. (2013). Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Internal Medicine, 173(8), pp. 632-638. American Medical Association 10.1001/jamainternmed.2013.3023

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IMPORTANCE Because effective interventions to reduce hospital readmissions are often expensive to implement, a score to predict potentially avoidable readmissions may help target the patients most likely to benefit. OBJECTIVE To derive and internally validate a prediction model for potentially avoidable 30-day hospital readmissions in medical patients using administrative and clinical data readily available prior to discharge. DESIGN Retrospective cohort study. SETTING Academic medical center in Boston, Massachusetts. PARTICIPANTS All patient discharges from any medical services between July 1, 2009, and June 30, 2010. MAIN OUTCOME MEASURES Potentially avoidable 30-day readmissions to 3 hospitals of the Partners HealthCare network were identified using a validated computerized algorithm based on administrative data (SQLape). A simple score was developed using multivariable logistic regression, with two-thirds of the sample randomly selected as the derivation cohort and one-third as the validation cohort. RESULTS Among 10 731 eligible discharges, 2398 discharges (22.3%) were followed by a 30-day readmission, of which 879 (8.5% of all discharges) were identified as potentially avoidable. The prediction score identified 7 independent factors, referred to as the HOSPITAL score: h emoglobin at discharge, discharge from an o ncology service, s odium level at discharge, p rocedure during the index admission, i ndex t ype of admission, number of a dmissions during the last 12 months, and l ength of stay. In the validation set, 26.7% of the patients were classified as high risk, with an estimated potentially avoidable readmission risk of 18.0% (observed, 18.2%). The HOSPITAL score had fair discriminatory power (C statistic, 0.71) and had good calibration. CONCLUSIONS AND RELEVANCE This simple prediction model identifies before discharge the risk of potentially avoidable 30-day readmission in medical patients. This score has potential to easily identify patients who may need more intensive transitional care interventions.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2168-6114

Publisher:

American Medical Association

Language:

English

Submitter:

Patricia Rajaonina

Date Deposited:

01 Apr 2014 08:40

Last Modified:

24 May 2017 09:13

Publisher DOI:

10.1001/jamainternmed.2013.3023

PubMed ID:

23529115

BORIS DOI:

10.7892/boris.44357

URI:

https://boris.unibe.ch/id/eprint/44357

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