Key result
LACE index modestly outperforms primary care provider assessment in predicting 30-day hospital readmission.
Why the study?
It was unknown whether primary care provider assessment of hospital readmission risk is comparable to the validated LACE tool.
Does the LACE readmission risk index improve prediction of 30-day hospital readmission compared to primary care provider assessment in recently discharged adult patients?
Observational (n=217)
Does the LACE readmission risk index improve prediction of 30-day hospital readmission compared to primary care provider assessment in recently discharged adult patients?
Effect estimate: AUROC (95% CI 0.55-0.76)
Absolute Event Rate: 0.65% vs 0.57%
The LACE index demonstrated modest predictive power for 30-day hospital readmission, outperforming subjective primary care provider assessment.
LACE modestly outperformed provider assessment for readmission risk; leaves open whether implementation improves outcomes or warrants adoption.
PURPOSE: This study aims to determine if the primary care provider (PCP) assessment of readmission risk is comparable to the validated LACE tool at predicting readmission to hospital. METHODS: A prospective observational study of recently discharged adult patients clustered by PCPs in the primary care setting. Physician readmission risk assessment was determined via a questionnaire after the PCP reviewed the hospital discharge summary. LACE scores were calculated using administrative data and the discharge summary. The sensitivity and specificity of the physician assessment and the LACE tool in predicting readmission risk, agreement between the 2 assessments and the area under receiver operating characteristic (AUROC) curves were calculated. RESULTS: 217 patient readmission encounters were included in this study from September 2017 till June 2018. The rate of readmission within 30 days was 14.7%, and 217 discharge summaries were used for analysis. The weighted kappa coefficient was 0.41 (95% CI: 0.30-0.51) demonstrating a moderate level of agreement. Sensitivity of physician assessment was 0.31 (95% CI: 0.22-0.40) and specificity was 0.80 (95% CI: 0.77-0.83). The sensitivity of the LACE assessment was 0.42 (95% CI: 0.25-0.59) and specificity was 0.79 (95% CI: 0.73-0.85). The AUROC for the LACE readmission risk was 0.65 (95% C.I. 0.55-0.76) demonstrating modest predictive power and was 0.57 (95% C.I. 0.46-0.68) for physician assessment, demonstrating low predictive power. CONCLUSION: The LACE index shows moderate discriminatory power in identifying high-risk patients for readmission when compared to the PCP's assessment. If this score can be provided to the PCP, it may help identify patients who requires more intensive follow-up after discharge.
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Walji et al. (2021) conducted an observational in Hospital readmission risk (n=217). LACE readmission risk index vs. Primary care provider (PCP) assessment was evaluated on Predicting readmission to hospital within 30 days (AUROC, 95% CI 0.55-0.76). The LACE index showed modest predictive power for 30-day hospital readmission (AUROC 0.65; 95% CI 0.55-0.76), which was higher than primary care provider assessment (AUROC 0.57; 95% CI 0.46-0.68).
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