Validation of the Hospital Score as Predictor of 30-Day Potentially Avoidable Readmissions in a Brazilian Population: Retrospective Cohort Study

Abstract

Background: Hospital readmissions are associated with several negative health outcomes and higher hospital costs. The HOSPITAL score is one of the tools developed to identify patients at high risk of hospital readmission, but its predictive capacity in more heterogeneous populations involving different diagnoses and clinical contexts is poorly understood. Objective: The aim of this study is to externally validate the HOSPITAL score in a hospitalized Brazilian population. Methods: A retrospective cohort study was carried out with patients over the age of 18 years in a tertiary university hospital. We performed a refitted HOSPITAL score with the same definitions and predictive variables included in the original HOSPITAL score and compared the predictive capacity of both. The receiver operating characteristic was constructed by comparing the performance risk forecasting tools measuring the area under the curve (AUC). Results: Of the 47,464 patients, 50.9% were over 60 years and 58.4% were male. The frequency of 30-day potentially avoidable readmission was 7.70%. The accuracy of original and refitted HOSPITAL scores was close, although statistically different ([Formula: see text]), AUC: 0.733 (CI 95%: 0.718, 0.748) and 0.7401 (CI 95%: 0.7256, 0.7547), respectively. The frequency of 60, 90, 180, and 365-days readmissions ranged from 10.60% to 18.30%. Conclusion: The original and refitted HOSPITAL score is a useful tool to identify patients at high risk of 30-day potentially avoidable readmission, in patients with different diagnoses in public tertiary hospitals. In this sense, our study expands and reinforces the usefulness of the HOSPITAL score as a tool that can be used as part of intervention strategies to reduce the rate of hospital readmission.