Key result
The addition of social factors to a clinical prediction model significantly improved discrimination for early (within 7 days) and late (8-30 days) readmissions after COPD hospitalization.
Why the study?
It was unknown whether adding social factors improves the predictive ability for overall 30-day, early (within 7 days), and late (8-30 days) readmissions in patients hospitalized for COPD.
Does the addition of social factors to a clinical prediction model improve the predictive ability for 30-day readmissions in patients hospitalized for COPD?
Cohort (n=905)
Does the addition of social factors to a clinical prediction model improve the predictive ability for 30-day readmissions in patients hospitalized for COPD?
Effect estimate: IDI 0.018 (95% CI 0.003-0.032)
Absolute Event Rate: 0.63% vs 0.57%
Adding social factors to clinical prediction models significantly improves the discrimination and reclassification for early and late readmissions following COPD hospitalization.
Should not yet change COPD readmission models; supports further validation of social factors in prediction.
BACKGROUND: To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8-30 days after discharge). METHODS: Patients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions. RESULTS: Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003-0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060-0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009-0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028-0.459]). CONCLUSIONS: In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.
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Goto et al. (2020) conducted a cohort in COPD exacerbation (n=905). Addition of social factors to prediction models vs. Reference model (age, comorbidities, mechanical ventilation) was evaluated on Discrimination ability (C-statistic) for early readmissions (within 7 days) (IDI 0.018, 95% CI 0.003-0.032). The addition of social factors to a clinical prediction model significantly improved discrimination for early (within 7 days) and late (8-30 days) readmissions after COPD hospitalization.
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