The HOSPITAL score predicted 30-day potentially avoidable readmissions with good discrimination (C statistic 0.72; 95% CI 0.72-0.72) and excellent calibration.
Cohort (n=117,065)
Yes
Does the HOSPITAL score predict 30-day potentially avoidable readmission in adult patients discharged from medical departments?
The HOSPITAL score is a valid tool with moderately high discrimination and excellent calibration for identifying medical patients at high risk of 30-day potentially avoidable readmission across international settings.
Effect estimate: C statistic 0.72 (95% CI 0.72-0.72)
IMPORTANCE: Identification of patients at a high risk of potentially avoidable readmission allows hospitals to efficiently direct additional care transitions services to the patients most likely to benefit. OBJECTIVE: To externally validate the HOSPITAL score in an international multicenter study to assess its generalizability. DESIGN, SETTING, AND PARTICIPANTS: International retrospective cohort study of 117 065 adult patients consecutively discharged alive from the medical department of 9 large hospitals across 4 different countries between January 2011 and December 2011. Patients transferred to another acute care facility were excluded. EXPOSURES: The HOSPITAL score includes the following predictors at discharge: hemoglobin, 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, and length of stay. MAIN OUTCOMES AND MEASURES: 30-day potentially avoidable readmission to the index hospital using the SQLape algorithm. RESULTS: Overall, 117 065 adults consecutively discharged alive from a medical department between January 2011 and December 2011 were studied. Of all medical discharges, 16 992 of 117 065 (14.5%) were followed by a 30-day readmission, and 11 307 (9.7%) were followed by a 30-day potentially avoidable readmission. The discriminatory power of the HOSPITAL score to predict potentially avoidable readmission was good, with a C statistic of 0.72 (95% CI, 0.72-0.72). As in the derivation study, patients were classified into 3 risk categories: low (n = 73 031 62.4%), intermediate (n = 27 612 23.6%), and high risk (n = 16 422 14.0%). The estimated proportions of potentially avoidable readmission for each risk category matched the observed proportion, resulting in an excellent calibration (Pearson χ2 test P = .89). CONCLUSIONS AND RELEVANCE: The HOSPITAL score identified patients at high risk of 30-day potentially avoidable readmission with moderately high discrimination and excellent calibration when applied to a large international multicenter cohort of medical patients. This score has the potential to easily identify patients in need of more intensive transitional care interventions to prevent avoidable hospital readmissions.
Donzé et al. (Tue,) conducted a cohort in Medical admission (n=117,065). HOSPITAL score was evaluated on 30-day potentially avoidable readmission to the index hospital using the SQLape algorithm (C statistic 0.72, 95% CI 0.72-0.72). The HOSPITAL score predicted 30-day potentially avoidable readmissions with good discrimination (C statistic 0.72; 95% CI 0.72-0.72) and excellent calibration.
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