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

Robert Robinson,Tamer Hudali

doi:10.7717/peerj.3137

Abstract

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.

Highlights

IntroductionExpensive, and a key target of the Medicare Value Based Purchasing (VBP) program
Hospital readmissions are common, expensive, and a key target of the Medicare Value Based Purchasing (VBP) program
Because of this high frequency and cost, hospital readmissions within 30 days of discharge are a target for health care cost savings in the Medicare Value Based Purchasing (VBP) program

Summary

Introduction

Expensive, and a key target of the Medicare Value Based Purchasing (VBP) program. Race, having a regular health care provider, major surgery, medical comorbidities, length of hospital stay, previous admissions in the last year, failure to transfer important information to the outpatient setting, discharging patients too soon, the number of medications at discharge, and many other risk factors for hospital readmission within 30 days (Auerbach et al, 2016; Picker et al, 2015; Hasan et al, 2010; Silverstein et al, 2008). Despite identifying with these risk factors, healthcare providers have poor accuracy in predicting which patients are at high risk of hospital readmission without a risk assessment tool (Allaudeen et al, 2011)

Objectives

Methods

Results

Discussion

Conclusion