Can we predict early 7-day readmissions using a standard 30-day hospital readmission risk prediction model?

Sameh N Saleh,Ethan A Halm,Oanh Kieu Nguyen,Anil N Makam

doi:10.1186/s12911-020-01248-1

Abstract

BackgroundDespite focus on preventing 30-day readmissions, early readmissions (within 7 days of discharge) may be more preventable than later readmissions (8–30 days). We assessed how well a previously validated 30-day EHR-based readmission prediction model predicts 7-day readmissions and compared differences in strength of predictors.MethodsWe conducted an observational study on adult hospitalizations from 6 diverse hospitals in North Texas using a 50–50 split-sample derivation and validation approach. We re-derived model coefficients for the same predictors as in the original 30-day model to optimize prediction of 7-day readmissions. We then compared the discrimination and calibration of the 7-day model to the 30-day model to assess model performance. To examine the changes in the point estimates between the two models, we evaluated the percent changes in coefficients.ResultsOf 32,922 index hospitalizations among unique patients, 4.4% had a 7-day admission and 12.7% had a 30-day readmission. Our original 30-day model had modestly lower discrimination for predicting 7-day vs. any 30-day readmission (C-statistic of 0.66 vs. 0.69, p ≤ 0.001). Our re-derived 7-day model had similar discrimination (C-statistic of 0.66, p = 0.38), but improved calibration. For the re-derived 7-day model, discharge day factors were more predictive of early readmissions, while baseline characteristics were less predictive.ConclusionA previously validated 30-day readmission model can also be used as a stopgap to predict 7-day readmissions as model performance did not substantially change. However, strength of predictors differed between the 7-day and 30-day model; characteristics at discharge were more predictive of 7-day readmissions, while baseline characteristics were less predictive. Improvements in predicting early 7-day readmissions will likely require new risk factors proximal to day of discharge.

Highlights

Despite focus on preventing 30-day readmissions, early readmissions may be more preventable than later readmissions (8–30 days)
Current risk prediction models often only identify patients at risk for 30-day readmission [8,9,10] and often fail to use electronic health record (EHR) data effectively to allow for real-time operationalization of the model [10, 11]
There is a paucity of research developing prediction models for adult 7-day readmissions [8, 12], which may be due to federal financial penalties tied to 30-day readmissions

Summary

Introduction

Despite focus on preventing 30-day readmissions, early readmissions (within 7 days of discharge) may be more preventable than later readmissions (8–30 days). Despite intense focus on preventing 30-day readmissions, early readmissions within the first 7 days of hospital discharge may be more preventable than later readmissions (8–30 days post-discharge) [1,2,3,4,5,6,7]. Identifying patients at risk for early, rather than later readmissions may be a more effective strategy to tailor resource-intensive transitional care interventions to prevent readmissions. We assessed how well a validated 30-day EHR-based readmission risk prediction model [13] would predict early 7-day readmissions, and whether there were differences in the strength of predictors for 7-day versus 30-day readmissions

Methods

Results

Conclusion