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Predicting Avoidable 30-Day Readmissions

Harvard study validates HOSPITAL score

In an international study, researchers have found that the HOSPITAL score, an acronym created to identify the variables associated with hospital readmissions, successfully predicted patients at high risk of a 30-day potentially avoidable readmission. The researchers believe this score may help identify patients in need of intense transitional-care interventions to prevent avoidable hospital readmissions. The findings were published in JAMA Internal Medicine.

“Interventions to reduce readmissions are demanding and complex. We need to target patients who are most likely to benefit, which means identifying who is at high risk for avoidable readmission,” said lead author Jacques Donzé, MD, MSc, a research associate at Brigham and Women’s Hospital and Harvard Medical School and an associate physician at the Bern University Hospital in Switzerland. “The three main advantages of this score are that it is simple to use; it can be calculated before discharge so that interventions can be started; and it performs well in many population and countries.”

Using data from 117,065 adult patients who were discharged from nine hospitals in four countries, the researchers estimated the risk of 30-day avoidable readmission using the following predictors at discharge: the hemoglobin level, discharge from an oncology service, the sodium level, the procedure during the index admission, the index type of admission (urgent), the number of admissions during the last 12 months, and the length of stay. Based on these seven predictors, each patient obtained scores ranging from 0 to 13, which reflected the risk of readmission.

Within 30 days after discharge, 15% of the medical patients had a readmission, and 9.7% had a potentially avoidable readmission. Using the HOSPITAL score, 62% of the patients were categorized as low risk, 24% as intermediate risk, and 14% as high risk for a potentially avoidable readmission. Patients identified as high risk (seven points or more) had four times the risk of being readmitted within 30 days compared with patients at low risk (four points or less).

The HOSPITAL score showed an excellent ability to identify patients at high risk for potentially avoidable readmission, the researchers reported. A 30-day potentially avoidable readmission was predicted with a 72% probability using the score. Moreover, the predicted probabilities of readmission in each risk category matched the real observed proportion of readmission.

Overall, patients with a potentially avoidable readmission had an urgent or emergent index admission; were more frequently discharged from an oncology service; had a length of stay exceeding five days; had more hospitalizations during the past year; were more likely to have had a procedure; and more often had a low hemoglobin or low sodium level at discharge.

“This score is easy to use and is currently the most widely validated prediction model for hospital readmission in medical patients. It remains to be shown whether interventions to reduce readmission are more efficient when targeted specifically to the high-risk patients according to the HOSPITAL score,” Donzé said.

Sources: Medical Xpress; March 7, 2016; and JAMA Internal Medicine; March 7, 2016.

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