Seven factors linked to avoidable 30-day hospital readmissions

To help put a dent in the billions spent annually on 30-day hospital readmissions, researchers at Boston-based Partners HealthCare developed a prediction model that identifies seven factors linked to avoidable hospital readmissions.

“This easy-to-use model enables physicians to prospectively identify approximately 27 percent of the patients at high risk of having a potentially avoidable readmission and would allow targeting intensive transitional care interventions to patients who might benefit the most,” concluded Jacques Donza, MD, a research associate at Brigham & Women’s Department of Medicine, in a JAMA Internal Medicine study published on March 25. This research also could inform hospitals susceptible to federal penalties for high readmission rates.

The study examined all patient discharges for any medical services - including general medicine, cardiology, oncology, bone marrow transplant, endocrinology, gastroenterology, hematology, infectious diseases, rheumatology and nephrology – between July 1, 2009 and June 30, 2010 at three hospitals in the Boston area. Among the 10,731 discharges, 2,398 (22.3 percent) were followed by a 30-day readmission, of which 879 (8.5 percent) were deemed as potentially avoidable.

Using a validated computerized algorithm based on administrative data, the prediction “HOSPITAL” score identified the following seven factors: (1) hemoglobin at discharge, (2) discharge from an oncology service, (3) sodium level at discharge, (4) procedure during the index admission, (5) index type of admission, (6) number of admissions during the last 12 months, and (7) length of stay.

“The HOSPITAL score had fair discriminatory power and had good calibration,” Donza et al wrote.

The research confirmed other studies that link the number of prior hospitalizations and the length of stay of the index admission as important predictors of potentially avoidable readmissions. Patients discharged from an oncology division “may be more fragile than most other medical service patients”, attributing their high rate, the study also said.

The addition of sodium level as a predictor of readmission, however, has not been identified in other studies “to our knowledge,” the researchers wrote

In their conclusion, Donza and colleagues said the prediction aid is only a proxy for identifying who might benefit from specific interventions. “Intervention studies targeting this patient population need to be done to definitively prove its usefulness,” according to the study.