Validation of the HOSPITAL Score for 30-Day All-Cause Readmissions of Patients Discharged to Skilled Nursing Facilities

Abstract

ObjectivesTo validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs). DesignRetrospective cohort. SettingCleveland Clinic Main Campus. ParticipantsCleveland Clinic Main Campus medicine services patients who were admitted between January 1, 2011, and December 31, 2012, and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. MeasurementsThirty-day all-cause readmissions to any hospital in the Cleveland Clinic Health System and the HOSPITAL score. ResultsDuring the study period, 4208 medical patients were discharged to 110 SNFs; 30-day all-cause readmission rates were 40.9% for high-risk patients, 28.1% for intermediate-risk patients, and 15.4% for low-risk patients. Compared to intermediate- and low-risk patients, high-risk patients had more hospitalizations in the past year (3.6 vs 1.1 vs 0.8; P < .0001), longer hospital stays (12.0 days vs 9.9 days vs 4.9 days; P < .0001) and more comorbidities, including end-stage renal disease (18.5% vs 9.3% vs 2.5%; P < .0001), congestive heart failure (39.9% vs 33.1% vs 26.1%; P < .0001), chronic obstructive pulmonary disease (26.9% vs 21.5% vs 20.2%; P < .0001), and diabetes (46.5% vs 38.6% vs 35.3%; P < .0001). The c--statistic for the HOSPITAL score was 0.65. ConclusionsAmong patients discharged to an SNF, the HOSPITAL score may be used to identify those at highest risk of readmission within 30 days.