Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients Derivation and Validation of a Prediction Model

Importance: Because effective interventions to reduce hospital readmissions are often expensive to implement, a score to predict potentially avoidable readmissions may help target the patients most likely to benefit. Objective: To derive and internally validate a prediction model for potentially avoidable 30- day hospital readmissions in medical patients using administrative and clinical data readily available prior to discharge. Design: Retrospective cohort study. Setting: Academic medical center in Boston, Massachusetts. Participants: All patient discharges from any medical services between July 1, 2009, and June 30, 2010. Main Outcome Measures: Potentially avoidable 30-day readmissions to 3 hospitals of the Partners Health-Care network were identified using a validated computerized algorithm based on administrative data (SQLape). A simple score was developed using multivariable logistic regression, with two-thirds of the sample randomly selected as the derivation cohort and one-third as the validation cohort. Results: Among 10 731 eligible discharges, 2398 discharges (22.3%) were followed by a 30- day readmission, of which 879 (8.5% of all discharges) were identified as potentially avoidable. The prediction score identified 7 independent factors, referred to as the HOSPITAL score: hemoglobin at discharge, discharge from an oncology service, sodium level at discharge, procedure during the index admission, index type of admission, number of admissions during the last 12 months, and length of stay. In the validation set, 26.7% of the patients were classified as high risk, with an estimated potentially avoidable readmission risk of 18.0% (observed, 18.2%). The HOSPITAL score had fair discriminatory power (C statistic, 0.71) and had good calibration. Conclusions and Relevance: This simple prediction model identifies before discharge the risk of potentially avoidable 30- day readmission in medical patients. This score has potential to easily identify patients who may need more intensive transitional care interventions.