International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions.

Donzé, Jacques; Williams, Mark V; Robinson, Edmondo J; Zimlichman, Eyal; Aujesky, Drahomir; Vasilevskis, Eduard E; Kripalani, Sunil; Metlay, Joshua P; Wallington, Tamara; Fletcher, Grant S; Auerbach, Andrew D; Schnipper, Jeffrey L (2016). International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions. JAMA Internal Medicine, 176(4), pp. 496-502. American Medical Association 10.1001/jamainternmed.2015.8462

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IMPORTANCE Identification of patients at a high risk of potentially avoidable readmission allows hospitals to efficiently direct additional care transitions services to the patients most likely to benefit. OBJECTIVE To externally validate the HOSPITAL score in an international multicenter study to assess its generalizability. DESIGN, SETTING, AND PARTICIPANTS International retrospective cohort study of 117 065 adult patients consecutively discharged alive from the medical department of 9 large hospitals across 4 different countries between January 2011 and December 2011. Patients transferred to another acute care facility were excluded. EXPOSURES The HOSPITAL score includes the following predictors at discharge: hemoglobin, discharge from an oncology service, sodium level, procedure during the index admission, index type of admission (urgent), number of admissions during the last 12 months, and length of stay. MAIN OUTCOMES AND MEASURES 30-day potentially avoidable readmission to the index hospital using the SQLape algorithm. RESULTS Overall, 117 065 adults consecutively discharged alive from a medical department between January 2011 and December 2011 were studied. Of all medical discharges, 16 992 of 117 065 (14.5%) were followed by a 30-day readmission, and 11 307 (9.7%) were followed by a 30-day potentially avoidable readmission. The discriminatory power of the HOSPITAL score to predict potentially avoidable readmission was good, with a C statistic of 0.72 (95% CI, 0.72-0.72). As in the derivation study, patients were classified into 3 risk categories: low (n = 73 031 [62.4%]), intermediate (n = 27 612 [23.6%]), and high risk (n = 16 422 [14.0%]). The estimated proportions of potentially avoidable readmission for each risk category matched the observed proportion, resulting in an excellent calibration (Pearson χ2 test P = .89). CONCLUSIONS AND RELEVANCE The HOSPITAL score identified patients at high risk of 30-day potentially avoidable readmission with moderately high discrimination and excellent calibration when applied to a large international multicenter cohort of medical patients. This score has the potential to easily identify patients in need of more intensive transitional care interventions to prevent avoidable hospital readmissions.

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

UniBE Contributor:

Donzé, Jacques and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2168-6114

Publisher:

American Medical Association

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

10 May 2017 12:47

Last Modified:

24 May 2017 09:00

Publisher DOI:

10.1001/jamainternmed.2015.8462

PubMed ID:

26954698

BORIS DOI:

10.7892/boris.94665

URI:

https://boris.unibe.ch/id/eprint/94665

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