Abstract
BackgroundHospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management. Several models to identify patients at risk of unplanned readmissions have been developed in Western countries, but little is known about their performance in other countries. This paper reports the possible utility of one such model developed in Canada, the LACE index, in patients in a tertiary hospital in Singapore.MethodsWe used administrative data from Singapore General Hospital for patients admitted between 1st January 2006 and 31st December 2010. Data such as demographic and clinical data including disease codes were extracted. The patient cohort was divided into two groups with a LACE index of 10 as the cutoff. Multivariate logistic regression analysis models were used to compare the outcomes between the two groups of patients with adjustment for age, sex, ethnicity, year of discharge, intensive care unit admission, and admission ward class.ResultsOverall, 127 550 patients were eligible for analysis. Patients with a LACE index ≥ 10 had a higher risk of 30-day unplanned readmission after index discharge (odds ratio [OR]: 4.37; 95% confidence interval [CI]: 4.18-4.57). After adjustment, the risk remained significant (OR: 4.88; 95% CI: CI 4.57-5.22). The C-statistic for the adjusted model was 0.70 (P < 0.001). Similar results were shown for 90-day unplanned readmission and emergency visits after the same adjustment.ConclusionThe use of the LACE index may have significant application in identifying medical patients at high risk of readmission and visits to the Emergency Department in Singapore.
Highlights
Hospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management
Patients with subsequent in-hospital deaths (n = 1 848), patients with index hospitalization in psychiatry wards (n = 644), and patients discharged to nursing homes or other intermediate–long-term care facilities (n = 2 819) after index hospitalization were excluded from the study, because the focus of the study was on patients who were discharged to their homes
A total of 20 055 (16%) patients had a LACE index ≥ 10. Patients in this group were older, and a higher proportion were from admission ward class C, had an intensive care unit (ICU) stay during their index admission, and had high Charlson Comorbidity Index (CCI)
Summary
Hospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management. This paper reports the possible utility of one such model developed in Canada, the LACE index, in patients in a tertiary hospital in Singapore. The hospital readmission rate is widely considered an indicator of quality in health care management. In the United States, one study reported that as many as 21% of medical patients were readmitted to hospital within 30 days of discharge. The cost of such unplanned readmission was estimated at USD 17.4 billion in 2004, contributing to almost 20% of all hospitalization costs [2]. A further analysis found that a LACE cutoff of 10 was able to discriminate patients into low and high risk for readmission, with a two-fold higher readmission risk and mortality risk in the high-risk group [9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
