Key result
High PAR-Risk Score linked to ~2.6-fold higher odds of 30-day potentially avoidable readmission.
Why the study?
The authors aimed to externally validate the PAR-Risk Score, a 12-item prediction model for potentially avoidable readmissions, in their local internal medicine patient cohort.
Does a high PAR-Risk Score accurately predict 30-day potentially avoidable hospital readmissions in older internal medicine patients?
Cohort (n=5,985)
No
Does a high PAR-Risk Score accurately predict 30-day potentially avoidable hospital readmissions in older internal medicine patients?
External validation of the PAR-Risk Score in a Swiss internal medicine cohort revealed limited overall discriminatory performance, highlighting the necessity of locally validating readmission prediction models before clinical implementation.
Answers are grounded in this paper and cite their sources.
High-risk PAR-Risk Score was associated with elevated 30-day PAR odds yet poor discrimination; leaves open local validation needs before any clinical adoption.
BACKGROUND: Readmission prediction models have been developed and validated for targeted in-hospital preventive interventions. We aimed to externally validate the Potentially Avoidable Readmission-Risk Score (PAR-Risk Score), a 12-items prediction model for internal medicine patients with a convenient scoring system, for our local patient cohort. METHODS: A cohort study using electronic health record data from the internal medicine ward of a Swiss tertiary teaching hospital was conducted. The individual PAR-Risk Score values were calculated for each patient. Univariable logistic regression was used to predict potentially avoidable readmissions (PARs), as identified by the SQLape algorithm. For additional analyses, patients were stratified into low, medium, and high risk according to tertiles based on the PAR-Risk Score. Statistical associations between predictor variables and PAR as outcome were assessed using both univariable and multivariable logistic regression. RESULTS: The final dataset consisted of 5,985 patients. Of these, 340 patients (5.7%) experienced a PAR. The overall PAR-Risk Score showed rather poor discriminatory power (C statistic 0.605, 95%-CI 0.575-0.635). When using stratified groups (low, medium, high), patients in the high-risk group were at statistically significant higher odds (OR 2.63, 95%-CI 1.33-5.18) of being readmitted within 30 days compared to low risk patients. Multivariable logistic regression identified previous admission within six months, anaemia, heart failure, and opioids to be significantly associated with PAR in this patient cohort. CONCLUSION: This external validation showed a limited overall performance of the PAR-Risk Score, although higher scores were associated with an increased risk for PAR and patients in the high-risk group were at significantly higher odds of being readmitted within 30 days. This study highlights the importance of externally validating prediction models.
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Higi et al. (2021) conducted a cohort in Internal medicine patients (n=5,985). High PAR-Risk Score (>10) vs. Low PAR-Risk Score (<3) was evaluated on Potentially avoidable hospital readmission (PAR) within 30 days (OR 2.63, 95% CI 1.33-5.18). Patients in the high-risk PAR-Risk Score group had significantly higher odds of a 30-day potentially avoidable readmission compared to low-risk patients (OR 2.63, 95% CI 1.33-5.18), though overall model discriminatory power was poor.
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