Readmissions of medical patients: an external validation of two existing prediction scores

Abstract

Readmissions are a complex phenomenon with not only medical conditions contributing but also system, cultural and environmental factors exerting a significant influence. It is possible that the heterogeneity of the population and health care systems may prohibit the creation of a simple prediction tool that can be used internationally.

Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries

“…Although multiple risk models have been composed trying to create readmission prediction models, most models do not perform satisfactorily in a European population 21. This was also demonstrated in our cohort; 53.8% had a low risk of readmission according to the HOSPITAL score (see online supplementary 1).…”

“…Previous large-scale studies were mostly performed in the USA, and due to the differences in healthcare systems, the results of these studies are probably not applicable to a European setting 21. This is because broader issues other than the underlying, medical condition, such as social and environmental factors, are increasingly recognised as having a contributory role in the cause of readmission 19 21.…”

Predicting 30-Day Readmissions in an Asian Population: Building a Predictive Model by Incorporating Markers of Hospitalization Severity

“…We intend to further develop these predictors into a risk score and externally validate the risk score in other health systems. Surprisingly, the performance of the LACE index in our study cohort was comparable to the Ontario population that it was first derived and performed better than the UK and Danish populations that the index was externally validated on [11,12]. …”

“…The most distinctive advantage of the LACE index is its replicability that allows external validation in populations beyond its original derivation setting. However, to date, the LACE index performed poorly when externally validated in an older UK population with a c -statistic 0.55 [11] and in Denmark c -statistic 0.648 [12]. …”

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

“…20 In a recent study among nearly 20,000 medical patients in Denmark, the HOSPITAL score was significantly better than the LACE score for identifying patients at risk of 30 day readmission (P<0.001). 21 …”