Ira L Leeds1, Vjollca Sadiraj2, James C Cox2, Xiaoxue Sherry Gao2, Timothy M Pawlik3, Kurt E Schnier4, John F Sweeney5. 1. Department of Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Tower 110, Baltimore, MD 21287, USA; Department of Surgery, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA. Electronic address: ileeds@jhmi.edu. 2. Department of Economics and Experimental Economics Center, Georgia State University, 14 Marietta Street NW, Atlanta, GA 30303, USA. 3. Department of Surgery, The Johns Hopkins Hospital, 600 N Wolfe Street, Tower 110, Baltimore, MD 21287, USA. 4. School of Social Sciences, Humanities and Arts, University of California - Merced, 5200 N Lake Road, Merced, CA 95343, USA. 5. Department of Surgery, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA.
Abstract
BACKGROUND: Little is known about how information available at discharge affects decision-making and its effect on readmission. We sought to define the association between information used for discharge and patients' subsequent risk of readmission. METHODS: 2009-2014 patients from a tertiary academic medical center's surgical services were analyzed using a time-to-event model to identify criteria that statistically explained the timing of discharges. The data were subsequently used to develop a time-varying prediction model of unplanned hospital readmissions. These models were validated and statistically compared. RESULTS: The predictive discharge and readmission regression models were generated from a database of 20,970 patients totaling 115,976 patient-days with 1,565 readmissions (7.5%). 22 daily clinical measures were significant in both regression models. Both models demonstrated good discrimination (C statistic = 0.8 for all models). Comparison of discharge behaviors versus the predictive readmission model suggested important discordance with certain clinical measures (e.g., demographics, laboratory values) not being accounted for to optimize discharges. CONCLUSIONS: Decision-support tools for discharge may utilize variables that are not routinely considered by healthcare providers. How providers will then respond to these atypical findings may affect implementation.
BACKGROUND: Little is known about how information available at discharge affects decision-making and its effect on readmission. We sought to define the association between information used for discharge and patients' subsequent risk of readmission. METHODS: 2009-2014 patients from a tertiary academic medical center's surgical services were analyzed using a time-to-event model to identify criteria that statistically explained the timing of discharges. The data were subsequently used to develop a time-varying prediction model of unplanned hospital readmissions. These models were validated and statistically compared. RESULTS: The predictive discharge and readmission regression models were generated from a database of 20,970 patients totaling 115,976 patient-days with 1,565 readmissions (7.5%). 22 daily clinical measures were significant in both regression models. Both models demonstrated good discrimination (C statistic = 0.8 for all models). Comparison of discharge behaviors versus the predictive readmission model suggested important discordance with certain clinical measures (e.g., demographics, laboratory values) not being accounted for to optimize discharges. CONCLUSIONS: Decision-support tools for discharge may utilize variables that are not routinely considered by healthcare providers. How providers will then respond to these atypical findings may affect implementation.
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