Validation of the HOSPITAL Score for 30-Day All-Cause Readmissions of Patients Discharged to Skilled Nursing Facilities

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• 作者：Luke D. Kim ; MD ; CMD^a ; ^{kiml2@ccf.org" class="auth_mail" title="E-mail the corresponding author} ; Lei Kou ; MA^b ; Barbara J. Messinger-Rapport ; MD ; PhD ; CMD^c ; Michael B. Rothberg ; MD ; MPH^d
• 关键词：Skilled nursing facilities ; hospital readmissions ; risk stratification
• 刊名：Journal of the American Medical Directors Association
• 出版年：2016
• 出版时间：1 September 2016
• 年：2016
• 卷：17
• 期：9
• 页码：863.e15-863.e18
• 全文大小：390 K

文摘

To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs).

bsSec_2">Design

bspara0015">Retrospective cohort.

bsSec_3">Setting

bspara0020">Cleveland Clinic Main Campus.

bsSec_4">Participants

bspara0025">Cleveland Clinic Main Campus medicine services patients who were admitted between January 1, 2011, and December 31, 2012, and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital.

bsSec_5">Measurements

bspara0030">Thirty-day all-cause readmissions to any hospital in the Cleveland Clinic Health System and the HOSPITAL score.

bsSec_6">Results

bspara0035">During the study period, 4208 medical patients were discharged to 110 SNFs; 30-day all-cause readmission rates were 40.9% for high-risk patients, 28.1% for intermediate-risk patients, and 15.4% for low-risk patients. Compared to intermediate- and low-risk patients, high-risk patients had more hospitalizations in the past year (3.6 vs 1.1 vs 0.8; P < .0001), longer hospital stays (12.0 days vs 9.9 days vs 4.9 days; P < .0001) and more comorbidities, including end-stage renal disease (18.5% vs 9.3% vs 2.5%; P < .0001), congestive heart failure (39.9% vs 33.1% vs 26.1%; P < .0001), chronic obstructive pulmonary disease (26.9% vs 21.5% vs 20.2%; P < .0001), and diabetes (46.5% vs 38.6% vs 35.3%; P < .0001). The c--statistic for the HOSPITAL score was 0.65.

bsSec_7">Conclusions

bspara0040">Among patients discharged to an SNF, the HOSPITAL score may be used to identify those at highest risk of readmission within 30 days.