Hospital Readmission in General Medicine Patients: A Prediction Model

Omar HASAN; David O MELTZER; Shimon A SHAYKEVICH; Chaim M BELL; Peter J KABOLI; Andrew D AUERBACH; Tosha B WETTERNECK; Vineet M ARORA; James ZHANG; Jeffrey L SCHNIPPER

doi:10.1007/s11606-009-1196-1

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Hospital Readmission in General Medicine Patients: A Prediction Model

Journal article

Open access

Peer reviewed

Hospital Readmission in General Medicine Patients: A Prediction Model

Omar HASAN, David O MELTZER, Shimon A SHAYKEVICH, Chaim M BELL, Peter J KABOLI, Andrew D AUERBACH, Tosha B WETTERNECK, Vineet M ARORA, James ZHANG and Jeffrey L SCHNIPPER

Journal of general internal medicine : JGIM, Vol.25(3), pp.211-219

2010

DOI: 10.1007/s11606-009-1196-1

PMCID: PMC2839332

PMID: 20013068

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Abstract

Background Previous studies of hospital readmission have focused on specific conditions or populations and generated complex prediction models. Objective To identify predictors of early hospital readmission in a diverse patient population and derive and validate a simple model for identifying patients at high readmission risk. Design Prospective observational cohort study. Patients Participants encompassed 10,946 patients discharged home from general medicine services at six academic medical centers and were randomly divided into derivation (n = 7,287) and validation (n = 3,659) cohorts. Measurements We identified readmissions from administrative data and 30-day post-discharge telephone follow-up. Patient-level factors were grouped into four categories: sociodemographic factors, social support, health condition, and healthcare utilization. We performed logistic regression analysis to identify significant predictors of unplanned readmission within 30 days of discharge and developed a scoring system for estimating readmission risk. Results Approximately 17.5% of patients were readmitted in each cohort. Among patients in the derivation cohort, seven factors emerged as significant predictors of early readmission: insurance status, marital status, having a regular physician, Charlson comorbidity index, SF12 physical component score, ≥1 admission(s) within the last year, and current length of stay >2 days. A cumulative risk score of ≥25 points identified 5% of patients with a readmission risk of approximately 30% in each cohort. Model discrimination was fair with a c-statistic of 0.65 and 0.61 for the derivation and validation cohorts, respectively. Conclusions Select patient characteristics easily available shortly after admission can be used to identify a subset of patients at elevated risk of early readmission. This information may guide the efficient use of interventions to prevent readmission.

Biological and medical sciences

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Medical sciences

Details

Title: Subtitle: Hospital Readmission in General Medicine Patients: A Prediction Model
Creators: Omar HASAN - Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
David O MELTZER - Department of Medicine and Harris School of Public Policy, University of Chicago, Chicago, IL, United States
Shimon A SHAYKEVICH - Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
Chaim M BELL - Departments of Medicine and Health Policy Management and Evaluation, University of Toronto and Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Canada
Peter J KABOLI - Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, IA, United States
Andrew D AUERBACH - University of California-San Francisco, San Francisco, CA, United States
Tosha B WETTERNECK - University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
Vineet M ARORA - Department of Medicine and Harris School of Public Policy, University of Chicago, Chicago, IL, United States
James ZHANG - Department of Medicine and Harris School of Public Policy, University of Chicago, Chicago, IL, United States
Jeffrey L SCHNIPPER - Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
Resource Type: Journal article
Publication Details: Journal of general internal medicine : JGIM, Vol.25(3), pp.211-219
DOI: 10.1007/s11606-009-1196-1
PMID: 20013068
PMCID: PMC2839332
NLM abbreviation: J Gen Intern Med
ISSN: 0884-8734
eISSN: 1525-1497
Publisher: Springer
Language: English
Date published: 2010
Academic Unit: Epidemiology; Internal Medicine
Record Identifier: 9984094219302771

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