Abstract
BackgroundTo investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8–30 days after discharge).MethodsPatients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions.ResultsFollowing 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003–0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060–0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009–0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028–0.459]).ConclusionsIn a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.
Highlights
To investigate whether, in patients hospitalized for Chronic obstructive pulmonary disease (COPD), the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions, and late readmissions (8–30 days after discharge)
As with claim-based models to predict 30-day readmission after hospitalization for other Hospital Readmissions Reduction Program (HRRP)-targeted conditions [10,11,12,13], several studies have identified predictors and developed prediction models for readmissions in patients hospitalized for COPD [8, 9, 14,15,16]
Despite the emerging evidence suggesting the involvement of non-clinical factors – such as social factors – in readmission processes [21,22,23], little is known about whether these factors improve prediction ability and how their contribution varies by timing after COPD hospitalization
Summary
In patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8–30 days after discharge). As with claim-based models to predict 30-day readmission after hospitalization for other HRRP-targeted conditions (e.g., heart failure) [10,11,12,13], several studies have identified predictors and developed prediction models for readmissions in patients hospitalized for COPD [8, 9, 14,15,16]. These models incorporated the basic demographics (e.g., age, sex), comorbidities, and in-hospital management (e.g., medication use), with reporting C-statistics of 0.63 to 0.72 [14, 16]. While several studies built prediction models using administrative datasets (e.g., Nationwide Readmission Database [NRD]), these datasets do not include the information on detailed social factors [9, 13, 17,18,19,20]
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