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Risk score predicts avoidable 30-day readmissions

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A simple risk scoring method has the potential to easily identify hospital patients in need of more intensive transitional care to reduce avoidable readmissions, say researchers.

They found that the HOSPITAL score, based on an acronym of comprising clinical variables linked, successfully predicted patients at high risk of a 30-day potentially avoidable readmission.

“We need to target patients who are most likely to benefit, which means identifying who is at high risk for avoidable readmission”

Jacques Donzé

The authors of the international study, published in JAMA Internal Medicine, said they believed the score may help identify those patients in need of intense transitional care interventions in order to prevent them needing to return to hospital.

The researchers used data from 117,065 adult patients who were discharged from nine different hospitals across four countries.

They estimated the risk of 30-day avoidable readmission using seven predictors at discharge – haemoglobin level, discharge from an oncology service, sodium level, procedure during the index admission, index type of admission, number of admissions during the last 12 months, and length of stay.

Based on the seven predictors, each patient obtained a score between 0 and 13, which reflected their risk of readmission.

Brigham and Women’s Hospital

Risk score predicts avoidable 30-day readmissions

Jacques Donzé

Within 30 days after discharge, 15%of the medical patients had a readmission, and 9.7% had a potentially avoidable readmission.

Using the HOSPITAL score, 62% of the patients were categorised as low risk, 24% as intermediate risk, and 14% as high risk for a potentially avoidable readmission.

Patients identified at high risk – with seven points or more – had four times the risk of being readmitted within 30-days, compared to patients deemed to be at low risk – with four points or less.

The score showed an “excellent ability” to identify patients at high risk for potentially avoidable readmission, said the researchers.

Lead author Dr Jacques Donzé, a research associate at Brigham and Women’s Hospital in the US and associate physician at Bern University Hospital in Switzerland, said: “The three main advantages of this score is that it is simple to use, it can be calculated before discharge so that interventions can be started, and it performs well in many population and countries.”

HOSPITAL predictors at discharge:

  • Hemoglobin level
  • discharge from an Oncology service
  • Sodium level
  • Procedure during the index admission
  • Index Type of admission (urgent)
  • number of Admissions during the last 12 months
  • Length of stay
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