Key result
The early HOSPITAL score using admission laboratory values performed similarly to the discharge model (AUROC 0.66) but significantly improved risk classification with a continuous NRI of 0.28.
Why the study?
Earlier stratification of 30-day readmission risk would allow more preparation time for transitional care interventions, prompting evaluation of the simplified HOSPITAL score using admission rather than discharge lab values.
Does the early HOSPITAL score perform similarly to the simplified HOSPITAL score in predicting 30-day unplanned readmission or death in medical inpatients?
Cohort (n=934)
Yes
Does the early HOSPITAL score perform similarly to the simplified HOSPITAL score in predicting 30-day unplanned readmission or death in medical inpatients?
The early HOSPITAL score, using admission lab values, performs similarly to the discharge-based score for predicting 30-day readmission or death, allowing for earlier risk stratification and transition care planning.
Answers are grounded in this paper and cite their sources.
Admission labs may enable earlier readmission risk stratification; leaves open whether this improves outcomes or warrants adoption.
BACKGROUND: The simplified HOSPITAL score is an easy-to-use prediction model to identify patients at high risk of 30-day readmission before hospital discharge. An earlier stratification of this risk would allow more preparation time for transitional care interventions. OBJECTIVE: To assess whether the simplified HOSPITAL score would perform similarly by using hemoglobin and sodium level at the time of admission instead of discharge. DESIGN: Prospective national multicentric cohort study. PARTICIPANTS: In total, 934 consecutively discharged medical inpatients from internal general services. MAIN MEASURES: We measured the composite of the first unplanned readmission or death within 30 days after discharge of index admission and compared the performance of the simplified score with lab at discharge (simplified HOSPITAL score) and lab at admission (early HOSPITAL score) according to their discriminatory power (Area Under the Receiver Operating characteristic Curve (AUROC)) and the Net Reclassification Improvement (NRI). KEY RESULTS: During the study period, a total of 3239 patients were screened and 934 included. In total, 122 (13.2%) of them had a 30-day unplanned readmission or death. The simplified and the early versions of the HOSPITAL score both showed very good accuracy (Brier score 0.11, 95%CI 0.10-0.13). Their AUROC were 0.66 (95%CI 0.60-0.71), and 0.66 (95%CI 0.61-0.71), respectively, without a statistical difference (p value 0.79). Compared with the model at discharge, the model with lab at admission showed improvement in classification based on the continuous NRI (0.28; 95%CI 0.08 to 0.48; p value 0.004). CONCLUSION: The early HOSPITAL score performs, at least similarly, in identifying patients at high risk for 30-day unplanned readmission and allows a readmission risk stratification early during the hospital stay. Therefore, this new version offers a timely preparation of transition care interventions to the patients who may benefit the most.
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Mathys et al. (2023) conducted a cohort in 30-day hospital readmission or death (n=934). Early HOSPITAL score (lab values at admission) vs. Simplified HOSPITAL score (lab values at discharge) was evaluated on Discriminatory power (AUROC) and Net Reclassification Improvement (NRI) for the composite of first unplanned readmission or death within 30 days (NRI 0.28, 95% CI 0.08-0.48, p=0.004). The early HOSPITAL score using admission laboratory values performed similarly to the discharge model (AUROC 0.66) but significantly improved risk classification with a continuous NRI of 0.28.
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