HOSPITAL score predicts risk of 30-day potentially avoidable readmission to hospital

1. The HOSPITAL score uses seven readily available clinical factors to estimate risk of 30-day potentially avoidable hospital readmission in this international study of medical inpatients.

2. The external validity of the test showed good performance and calibration for further generalizability, and this tool could be used to more judiciously appropriate resources towards the higher risk population to reduce readmission rates.

Evidence Rating Level: 2 (Good)

Study Rundown: Preventing hospital readmissions has become a key focus for quality improvement in health care and reducing associated health care costs. Interventions to reduce risk of readmission have been shown to be effective but are labor and resource intensive. Identifying patients at highest risk for preventable readmission could help guide directed interventions.

The described study sought to externally validate a previously developed clinical prediction tool in an international population of medical inpatients from 9 hospitals in 4 countries. The HOSPITAL score consisted of readily obtained clinical factors: Hemoglobin, discharge from an Oncology service, Sodium level, Procedure performed, Index Type of admission (urgent vs. elective), number of Admissions in the last year, and Length of stay. The HOSPITAL score was able to discriminate risk of potentially avoidable readmission based on three risk categories (low, intermediate, and high). The actual 30-day readmission rates were similar to the predicted rates. While the prediction tool did identify patients at high risk for readmissions, it did not identified modifiable risk factors that could be specifically altered to change readmissions. Rather, the tool could be used to more judiciously appropriate resources towards the higher risk population to reduce readmission rates.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Predicting 30-day all-cause hospital readmissions

In-Depth [retrospective cohort]: The described study examined 117 065 medical inpatients admitted for greater than 1 day between January 1 and December 31, 2011 at 9 hospitals in 4 countries. There were 16 992 readmissions within 30 days with 11 307 (9.7%) deemed to be potentially avoidable. HOSPITAL scores were calculated for all patients who were then grouped into low, intermediate, and high-risk categories. The C-score for discriminatory power in risk prediction for the HOSPITAL tool was 0.72 (95%CI 0.72-0.72). The calibration of the HOSPITAL score was also excellent (Pearson chi-squared p-value of 0.89), with the predicted risks similar to actual readmission rates: 5% predicted vs 5.8% actual for low risk, 10% vs. 11.9% for intermediate risk, and 20% vs. 22.8% for high risk.

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