Modelo preditivo do risco de readmissão hospitalar no contexto brasileiro

Abstract

Hospital readmission has been used as a health care outcome indicator. Considering that readmissions are considered avoidable, expose patients to unnecessary risks and represent excessive costs, it is relevant to identify patients with high risk of readmission. In this perspective, several predictive models have been developed, among which the LACE index (L -length of stay; A -acuity of the admission; C -Charlson comorbidity index score; e E -emergency department use) stands out as an easily applicable tool, structured in data frequently available in health services and with clinically relevant results. Objective: to analyze the predictive ability of hospital readmission by a score of identification of readmission risk in the Brazilian context. Methods: a retrospective analytical observational study was carried out in a general hospital with important insertion in the health care network. All hospital admissions whose discharges occurred in the period from January to December 2019 were considered eligible. The following variables were analyzed: age, age group, gender, main and secondary diagnosis, origin, length of stay, character of hospitalization, Charlson Comorbidity Index, emergency department visits, and LACE index. Analysis performed according to lines of care, conditions of interest and age groups.Demographic data and characterization of hospitalization were analyzed according to the outcome (readmitted or not readmitted), using the nonparametric Mann-Whitney test and the chi-square test. Analysis of the predictive capacity of the score was performed using the discrimination measure with calculation of the area under the curve of receiver operating characteristics. Results: 22,687 patients were included, of whom 13.44% were readmitted within 30 days. The median LACE index was 5 (IQR: 3.00; 8.00) and was higher for readmitted patients 6.00 (IQR: 4.00; 9.00), p<0.001. 12.86% of patients were classified as high risk for readmission and the index discrimination was 0.561 (CI: 0.549; 0.572). In the analysis of the LACE index across lines of care, conditions of interest and age groups, difference was observed between readmitted and non-readmitted for cardiovascular diseases (p=0.002), cancer (p=0.003), under 5 years (p<0.001), children and adolescents (p<0.001), adults (p<0.001), elderly (p<0.001). The discrimination by analysis group was 0.524 (p=0.209) for Primary Care Sensitive Conditions, 0.542 (p=0.374) for Diabetes Mellitus, 0.416 (p=0.244) for Systemic Arterial Hypertension, 0.548 (p=0.004) for Cardiovascular Diseases, 0, 644 (p=0.096) for Stroke, 0.525 (p=0.546) for Chronic Respiratory Diseases, 0.539 (p=0.003) for Cancer, 0.591 (p<0.001) for children under five, 0.593 (p<0.001) for children and adolescents, 0.543 (p<0.001) for adults, and 0.539 (p<0.001) for the elderly. Conclusions: the differences observed between the groups of readmitted and non-readmitted patients indicate that the LACE index helps to identify the risk of readmission, although its low predictive capacity prevents its isolated use. ...