Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients

Abstract

Background Identifying patients at high risk of hospital preventable readmission is an essential step towards selecting those who might benefit from specific transitional interventions. Objective Derive and validate a predictive risk score for potentially avoidable readmission (PAR) based on analysis of readmissions, with a focus on medication. Design/Setting/Participants Retrospective analysis of all hospital admissions to internal medicine wards between 2011 and 2014. Comparison between patients readmitted within 30 days and non-readmitted patients, as identified using a specially designed algorithm. Univariate and multivariate regression analyses of demographic data, clinical diagnoses, laboratory results, and the medication data of patients admitted during the first period (2011–2013), to identify factors associated with PAR. Using these, derive a predictive score with a regression coefficient-based scoring method. Subsequently, validate this score with a second cohort of patients admitted in 2013–2014. Variables were identified at hospital discharge. Results The derivation cohort included 7,317 hospital stays. Multivariate logistic regressions found significant associations with PAR for: [adjusted OR (95% CI)] hospital length of stay > 4 days [1.3 (1.1–1.7)], admission in previous 6 months [2.3 (1.9–2.8)], heart failure [1.3 (1.0–1.7)], chronic ischemic heart disease [1.7 (1.2–2.3)], diabetes with organ damage [2.2 (1.3–3.8)], cancer [1.4 (1.0–1.9)], metastatic carcinoma [1.9 (1.3–3.0)], anemia [1.2 (1.0–1.5)], hypertension [1.3 (1.1–1.7)], arrhythmia [1.3 (1.0–1.6)], hyperkalemia [1.4 (1.0–1.7)], opioid drug prescription [1.3 (1.1–1.6)], and acute myocardial infarction [0.6 (0.4–0.9)]. The PAR-Risk Score, derived from these results, demonstrated fair discriminatory and calibration power (C-statistic = 0.699; Brier Score = 0.069). The results for the validation cohort’s operating characteristics were similar (C-statistic = 0.687; Brier Score = 0.064). Conclusion This study identified routinely-available factors that were significantly associated with PAR. A predictive score was derived and internally validated.

Assessment Rates and Causes of Readmissions in Military Casualties

“…We also found that longer LOS within the index admission puts patients at risk of multiple and longer readmission events. This result is partially consistent with some other studies on internal medicine patients conducted in civilian settings (4,17,20), which examined a much shorter post-discharge period than the present study. Still, a longer LOS seems to be an important factor for predicting the risk of repeated future readmissions.…”

Risk of 30-day hospital readmission associated with medical conditions and drug regimens of polymedicated, older inpatients discharged home: a registry-based cohort study

“…Taking beta-blocking agents, calcium channel blockers, diuretics, hypoglycaemic drugs or opioids was a significant risk for 30-day readmission. 9 Besides the higher risk of drug-related hospital readmission, some studies have also investigated the associations between combining drugs-a common practice when treating complex diseases or coexisting medical conditions-and drug-related hospital readmissions. Although using multiple drugs may be good clinical practice and compliant with guidelines for treating certain diseases, one significant consequence of combining drugs is that patients face much higher risk of ADEs, which can be caused by drug-drug interactions.…”

Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system

“…Other factors, such as malignancy [ 31 ] and previous admission [ 32 , 33 ] were previously suggested to be related to the readmission rate. A previous study in older adults suggested that malignant solid tumour was significantly associated with 10 times higher risk for hospital admission [ 34 ].…”