Validation of a Predictive Model to Identify Patients at High Risk for Hospital Readmission

Spiva, LeeAnna; Hand, Marti; VanBrackle, Lewis; McVay, Frank

doi:10.1111/jhq.12070

Cited by 27 publications

(21 citation statements)

References 17 publications

(21 reference statements)

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“…The authors concluded that more details are needed and should be added to the LACE index to improve its performance in predicting readmission (Cotter et al, 2012). Multiple other studies validated the moderate discrimination and good fit of the LACE index of predicting readmission (Garrison et al, 2016; Spiva et al, 2016; Van Walraven et al, 2010). …”

Section: Discussionmentioning

confidence: 84%

“…The LACE index has variable results in the literature outside Ontario. The LACE index has been shown to have moderate discrimination in studies conducted in North America with over 26,000 Medicare admissions (Garrison et al, 2016), 110,000 discharges in the Chicago, Illinois area (Tong et al, 2016) and 600 patients in a community hospital (Spiva et al, 2016). The LACE index had fair discrimination in a study of 5,800 patients in Singapore (Low et al, 2015) and poor discrimination in a study done on about 500 patients in UK with an average age of 85 years old (Cotter et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

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The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

Robinson

Hudali

2017

PeerJ

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IntroductionHospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Validated risk assessment tools such as the HOSPITAL score and LACE index have been developed to identify patients at high risk of hospital readmission so they can be targeted for interventions aimed at reducing the rate of readmission. This study aims to evaluate the utility of HOSPITAL score and LACE index for predicting hospital readmission within 30 days in a moderate-sized university affiliated hospital in the midwestern United States.Materials and MethodsAll adult medical patients who underwent one or more ICD-10 defined procedures discharged from the SIU-SOM Hospitalist service from Memorial Medical Center (MMC) from October 15, 2015 to March 16, 2016, were studied retrospectively to determine if the HOSPITAL score and LACE index were a significant predictors of hospital readmission within 30 days.ResultsDuring the study period, 463 discharges were recorded for the hospitalist service. The analysis includes data for the 432 discharges. Patients who died during the hospital stay, were transferred to another hospital, or left against medical advice were excluded. Of these patients, 35 (8%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation of the HOSPITAL score for this patient population shows a C statistic of 0.75 (95% CI [0.67–0.83]), indicating good discrimination for hospital readmission. The Brier score for the HOSPITAL score in this setting was 0.069, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 3.71 with a p value of 0.59. A receiver operating characteristic evaluation of the LACE index for this patient population shows a C statistic of 0.58 (95% CI [0.48–0.68]), indicating poor discrimination for hospital readmission. The Brier score for the LACE index in this setting was 0.082, indicating good overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 4.97 with a p value of 0.66.DiscussionThis single center retrospective study indicates that the HOSPITAL score has superior discriminatory ability when compared to the LACE index as a predictor of hospital readmission within 30 days at a medium-sized university-affiliated teaching hospital.ConclusionsThe internationally validated HOSPITAL score may be superior to the LACE index in moderate-sized community hospitals to identify patients at high risk of hospital readmission within 30 days.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

Robinson

Hudali

2017

PeerJ

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“…The LACE index has been useful and accurate in a study of 26,000 hospital admissions of Medicare patients, 13 110,000 discharges from multiple hospitals in the Chicago, Illinois area, 18 and 600 patients from a community hospital. 19 The LACE index had fair discrimination in a study of 5,800 patients in Singapore 20 and poor discrimination for 500 hospital discharges with an average age of 85 years in the UK. 21 Direct comparison of the LACE index and HOSPITAL score in a nationwide Medicare sample failed to show a significant difference between the two risk-prediction models.…”

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confidence: 97%

Vital Sign Abnormalities on Discharge Do Not Predict 30-Day Readmission

2019

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Objective: Hospital readmissions are common and expensive. Risk factors for hospital readmission may include vital sign abnormalities (VSA) at the time of discharge. The study aimed to validate VSA at the time of discharge as a useful predictor of hospital readmission within 30 days of discharge. VSA was compared to the validated HOSPITAL score and LACE index readmission risk prediction models.Design: All adult medical patients discharged from internal medicine hospitalist service were studied retrospectively. Variables such as age, gender, diagnoses, vital signs at discharge, 30-day hospital readmission, and components for the HOSPITAL score and LACE index were extracted from the electronic health record for analysis. Settings:A 507-bed university-affiliated tertiary care center. Participants:During the 2-year study period, a cohort of 1,916 discharges for the hospitalist service were evaluated. The final analysis was based on the data from 1,781 hospital discharges that met the inclusion criteria.Results: VSA was found in 13% of the study population. Only one abnormal vital sign was present in a higher proportion readmitted to the hospital within 30 days of discharge. No discharges had three or more unstable vital signs. Receiver operating characteristic (ROC) comparisons of the HOSPITAL score (C statistic of 0.67, P < 0.001), LACE index (C statistic of 0.61, P < 0.001), and VSA (C statistic of 0.52, P = 0.318) indicated that VSA at time of discharge was not a useful predictor of hospital readmission within 30 days of discharge. Conclusion:Our study indicated that VSA at the time of discharge is not a useful predictor of 30-day hospital readmission at a university-affiliated teaching hospital. The more complex and validated HOSPITAL score and LACE index were useful predictors of hospital readmission in this patient population.

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“…The LACE index predicted readmission and death within 30 days of discharge in a large cohort in Canada. In 2 retrospective studies of recently hospitalized patients in the United States, the LACE index's ability to discriminate between patients readmitted or not ranged from slightly better than chance to moderate (C statistic 0.56‐0.77) …”

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confidence: 99%

Preparedness for hospital discharge and prediction of readmission

Mixon

Goggins

Bell

et al. 2016

Journal of Hospital Medicine

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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.

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Validation of a Predictive Model to Identify Patients at High Risk for Hospital Readmission

Abstract: Findings support the use of the LACE index as a practical tool to identify patients at risk for readmission.

Cited by 27 publications

References 17 publications

The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

Vital Sign Abnormalities on Discharge Do Not Predict 30-Day Readmission

Preparedness for hospital discharge and prediction of readmission

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