Carole E Aubert1, Jeffrey L Schnipper2,3, Mark V Williams4, Edmondo J Robinson5, Eyal Zimlichman6, Eduard E Vasilevskis7,8,9, Sunil Kripalani7,8, Joshua P Metlay10, Tamara Wallington11, Grant S Fletcher12, Andrew D Auerbach13, Drahomir Aujesky1, Jacques D Donzé1,2,3. 1. Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 2. BWH Hospitalist Service, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA. 3. Harvard Medical School, Boston, Massachusetts, USA. 4. Center for Health Services Research, University of Kentucky, Kentucky, USA. 5. Value Institute, Christiana Care Health System, Wilmington, Delaware, USA. 6. Sheba Medical Center, Tel Hashomer, Israel. 7. Section of Hospital Medicine, Division of General Internal Medicine and Public Health Vanderbilt University, Nashville, TN, USA. 8. Center for Clinical Quality and Implementation Research, Vanderbilt University, Nashville, TN, USA. 9. VA Tennessee Valley - Geriatric Research, Education and Clinical Center (GRECC), Nashville, TN, USA. 10. Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. 11. William Osler Health System, Ontario, Canada. 12. Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA. 13. Division of Hospital Medicine, University of California, San Francisco, USA.
Abstract
OBJECTIVE: The HOSPITAL score has been widely validated and accurately identifies high-risk patients who may mostly benefit from transition care interventions. Although this score is easy to use, it has the potential to be simplified without impacting its performance. We aimed to validate a simplified version of the HOSPITAL score for predicting patients likely to be readmitted. DESIGN AND SETTING: Retrospective study in 9 large hospitals across 4 countries, from January through December 2011. PARTICIPANTS: We included all consecutively discharged medical patients. We excluded patients who died before discharge or were transferred to another acute care facility. MEASUREMENTS: The primary outcome was any 30-day potentially avoidable readmission. We simplified the score as follows: (1) 'discharge from an oncology division' was replaced by 'cancer diagnosis or discharge from an oncology division'; (2) 'any procedure' was left out; (3) patients were categorised into two risk groups (unlikely and likely to be readmitted). The performance of the simplified HOSPITAL score was evaluated according to its overall accuracy, its discriminatory power and its calibration. RESULTS: Thirty-day potentially avoidable readmission rate was 9.7% (n=11 307/117 065 patients discharged). Median of the simplified HOSPITAL score was 3 points (IQR 2-5). Overall accuracy was very good with a Brier score of 0.08 and discriminatory power remained good with a C-statistic of 0.69 (95% CI 0.68 to 0.69). The calibration was excellent when comparing the expected with the observed risk in the two risk categories. CONCLUSIONS: The simplified HOSPITAL score has good performance for predicting 30-day readmission. Prognostic accuracy was similar to the original version, while its use is even easier. This simplified score may provide a good alternative to the original score depending on the setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: The HOSPITAL score has been widely validated and accurately identifies high-risk patients who may mostly benefit from transition care interventions. Although this score is easy to use, it has the potential to be simplified without impacting its performance. We aimed to validate a simplified version of the HOSPITAL score for predicting patients likely to be readmitted. DESIGN AND SETTING: Retrospective study in 9 large hospitals across 4 countries, from January through December 2011. PARTICIPANTS: We included all consecutively discharged medical patients. We excluded patients who died before discharge or were transferred to another acute care facility. MEASUREMENTS: The primary outcome was any 30-day potentially avoidable readmission. We simplified the score as follows: (1) 'discharge from an oncology division' was replaced by 'cancer diagnosis or discharge from an oncology division'; (2) 'any procedure' was left out; (3) patients were categorised into two risk groups (unlikely and likely to be readmitted). The performance of the simplified HOSPITAL score was evaluated according to its overall accuracy, its discriminatory power and its calibration. RESULTS: Thirty-day potentially avoidable readmission rate was 9.7% (n=11 307/117 065 patients discharged). Median of the simplified HOSPITAL score was 3 points (IQR 2-5). Overall accuracy was very good with a Brier score of 0.08 and discriminatory power remained good with a C-statistic of 0.69 (95% CI 0.68 to 0.69). The calibration was excellent when comparing the expected with the observed risk in the two risk categories. CONCLUSIONS: The simplified HOSPITAL score has good performance for predicting 30-day readmission. Prognostic accuracy was similar to the original version, while its use is even easier. This simplified score may provide a good alternative to the original score depending on the setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Entities:
Keywords:
Adverse events, epidemiology and detection; Hospital medicine; Risk management; Transitions in care
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