Preparedness for hospital discharge and prediction of readmission

Abstract

Background, Objective Patients’ self-reported preparedness for discharge has been shown to predict readmission. It is unclear what differences exist in the predictive abilities of two available discharge preparedness measures. In order to address this gap, we conducted a comparison of these measures. Design, Setting, Patients Adults hospitalized for cardiovascular diagnoses were enrolled in a prospective cohort. Measurements Two patient-reported preparedness measures assessed during post-discharge calls: the 11-item Brief Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services (B-PREPARED) and the 3-item Care Transitions Measure (CTM-3). Cox proportional hazard models analyzed the relationship between preparedness and time to first readmission or death at 30 and 90 days, adjusted for readmission risk using the administrative database-derived Length of stay, Acuity, Comorbidity, and Emergency department use (LACE) index and other covariates. Results Median preparedness scores were: B-PREPARED 21 (interquartile range, IQR 18–22) and CTM-3 77.8 (IQR 66.7–100). In individual Cox models, a 4-point increase in B-PREPARED score was associated with a 16% decrease in time to readmission or death at 30 and 90 days. A 10-point increase in CTM-3 score was not associated with readmission or death at 30 days but was associated with a 6% decrease in readmission or death at 90 days. In models with both preparedness scores, B-PREPARED retained an association with readmission or death at both 30 and 90 days. However, neither preparedness score was as strong a predictor as the LACE index when all were included in the model predicting 30 and 90 day readmission or death. Conclusion The B-PREPARED score was more strongly associated with readmission or death than the more widely adopted CTM-3, but neither predicted readmission as well as the LACE index.

Preventing hospital readmissions: the importance of considering ‘impactibility,’ not just predicted risk

“…Yet, very few studies have examined whether data collected prospectively from patients add to the predictive power of existing risk models for readmissions. Mixon and colleagues examined an 11-item measure that assesses how prepared patients feel when leaving the hospital (B-HOSPITAL) 31. They concluded that it did not add meaningfully to the LACE index when predicting 30-day readmissions for patients with cardiovascular diseases, but might still help to direct care transition quality improvement efforts.…”

Validity and reliability of the Turkish version of the readiness for hospital discharge scale/short form

“…Assessing patients' readiness for discharge is becoming increasingly important for ensuring their safety, satisfaction, and physical, emotional, and social outcomes (Weiss, Ryan, & Lokken, 2006;Weiss et al, 2007). Recent research has offered convincing evidence that discharge readiness is associated with readmission likelihood, and even mortality (Coffey & McCarthy, 2013;Mixon et al, 2016;Weiss et al, 2007). To ensure safe discharge, patients' readiness for discharge must be assessed accurately (Patel & Mourad, 2015).…”

The Care Transitions Measure-3 Is Only Weakly Associated with Post-discharge Outcomes: a Retrospective Cohort Study in 48,384 Albertans

“…Mixon and colleagues also recently reported that the CTM-3 score was not significantly associated with 30day or 3-month death/readmission in 1239 patients with cardiovascular diagnoses in Tennessee-the c-statistic for the CTM-3 score was only 0.52 for 30-day outcomes in their study. 21 While an examination of the Medicare Hospital Compare database reported statistically significant inverse relations between CTM-3 scores and 30-day readmission rates after hospitalizations for heart failure, pneumonia, or acute myocardial infarction, all of the correlations were weak (with correlation coefficients between − 0.20 and − 0.30). 22 We found that patients who received the HCAHPS survey differed from those who were not surveyed in several baseline factors-this was not surprising since AHS selected medical and surgical patients and excluded psychiatric patients and certain obstetric cases from the HCAHPS surveys.…”