The HOSPITAL Score Predicts Potentially Preventable 30-Day Readmissions in Conditions Targeted by the Hospital Readmissions Reduction Program.

Burke, Robert E; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Vasilevskis, Eduard E; Kripalani, Sunil; Metlay, Joshua P; Fletcher, Grant S; Auerbach, Andrew D; Donzé, Jacques (2017). The HOSPITAL Score Predicts Potentially Preventable 30-Day Readmissions in Conditions Targeted by the Hospital Readmissions Reduction Program. Medical Care, 55(3), pp. 285-290. Lippincott Williams & Wilkins 10.1097/MLR.0000000000000665

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BACKGROUND/OBJECTIVES

New tools to accurately identify potentially preventable 30-day readmissions are needed. The HOSPITAL score has been internationally validated for medical inpatients, but its performance in select conditions targeted by the Hospital Readmission Reduction Program (HRRP) is unknown.

DESIGN

Retrospective cohort study.

SETTING

Six geographically diverse medical centers.

PARTICIPANTS/EXPOSURES

All consecutive adult medical patients discharged alive in 2011 with 1 of the 4 medical conditions targeted by the HRRP (acute myocardial infarction, chronic obstructive pulmonary disease, pneumonia, and heart failure) were included. Potentially preventable 30-day readmissions were identified using the SQLape algorithm. The HOSPITAL score was calculated for all patients.

MEASUREMENTS

A multivariable logistic regression model accounting for hospital effects was used to evaluate the accuracy (Brier score), discrimination (c-statistic), and calibration (Pearson goodness-of-fit) of the HOSPITAL score for each 4 medical conditions.

RESULTS

Among the 9181 patients included, the overall 30-day potentially preventable readmission rate was 13.6%. Across all 4 diagnoses, the HOSPITAL score had very good accuracy (Brier score of 0.11), good discrimination (c-statistic of 0.68), and excellent calibration (Hosmer-Lemeshow goodness-of-fit test, P=0.77). Within each diagnosis, performance was similar. In sensitivity analyses, performance was similar for all readmissions (not just potentially preventable) and when restricted to patients age 65 and above.

CONCLUSIONS

The HOSPITAL score identifies a high-risk cohort for potentially preventable readmissions in a variety of practice settings, including conditions targeted by the HRRP. It may be a valuable tool when included in interventions to reduce readmissions within or across these conditions.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Donzé, Jacques

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0025-7079

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

10 May 2017 12:42

Last Modified:

09 Feb 2018 14:52

Publisher DOI:

10.1097/MLR.0000000000000665

PubMed ID:

27755392

BORIS DOI:

10.7892/boris.94660

URI:

https://boris.unibe.ch/id/eprint/94660

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