Key result
The refitted HOSPITAL score demonstrated slightly higher predictive capacity compared to the original score for 30-day potentially avoidable readmissions (AUC 0.7401 vs 0.733).
Why the study?
The HOSPITAL score identifies patients at high risk of readmission, but its predictive capacity in heterogeneous populations across different diagnoses and clinical contexts is poorly understood.
Does the HOSPITAL score accurately predict 30-day potentially avoidable readmissions in a hospitalized Brazilian population?
Cohort (n=47,464)
No
Does the HOSPITAL score accurately predict 30-day potentially avoidable readmissions in a hospitalized Brazilian population?
Absolute Event Rate: 0.7401% vs 0.733%
May aid readmission risk stratification in Brazilian hospitals; extends HOSPITAL score validation to heterogeneous populations but leaves prospective utility open.
Background: Hospital readmissions are associated with several negative health outcomes and higher hospital costs. The HOSPITAL score is one of the tools developed to identify patients at high risk of hospital readmission, but its predictive capacity in more heterogeneous populations involving different diagnoses and clinical contexts is poorly understood. Objective: The aim of this study is to externally validate the HOSPITAL score in a hospitalized Brazilian population. Methods: A retrospective cohort study was carried out with patients over the age of 18 years in a tertiary university hospital. We performed a refitted HOSPITAL score with the same definitions and predictive variables included in the original HOSPITAL score and compared the predictive capacity of both. The receiver operating characteristic was constructed by comparing the performance risk forecasting tools measuring the area under the curve (AUC). Results: Of the 47,464 patients, 50.9% were over 60 years and 58.4% were male. The frequency of 30-day potentially avoidable readmission was 7.70%. The accuracy of original and refitted HOSPITAL scores was close, although statistically different ([Formula: see text]), AUC: 0.733 (CI 95%: 0.718, 0.748) and 0.7401 (CI 95%: 0.7256, 0.7547), respectively. The frequency of 60, 90, 180, and 365-days readmissions ranged from 10.60% to 18.30%. Conclusion: The original and refitted HOSPITAL score is a useful tool to identify patients at high risk of 30-day potentially avoidable readmission, in patients with different diagnoses in public tertiary hospitals. In this sense, our study expands and reinforces the usefulness of the HOSPITAL score as a tool that can be used as part of intervention strategies to reduce the rate of hospital readmission.
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Silva et al. (2022) conducted a cohort in Hospitalized patients at risk of readmission (n=47,464). Refitted HOSPITAL score vs. Original HOSPITAL score was evaluated on Predictive capacity (AUC) for 30-day potentially avoidable readmission. The refitted HOSPITAL score demonstrated slightly higher predictive capacity compared to the original score for 30-day potentially avoidable readmissions (AUC 0.7401 vs 0.733).
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