期刊
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
卷 6, 期 4, 页码 429-435出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCOUTCOMES.111.000093
关键词
outcomes research; percutaneous coronary intervention; performance measures
资金
- Massachusetts Department of Public Health
- American Heart Association [12CRP9010016]
- Abbott Vascular
- Bard Peripheral Vascular
- Ownership Interest
- Lumen Biomedical
- Medical Stimulation Corp
- VIVA Physicians Association
- Consultant/Advisory Board
- Angioguard
- Boston Scientific
- Complete Conference Manager
- Harvard Clinical Research Institute
- Abbott
- Cordis
- Medtronic
- Eli Lilly
- Daiichi Sankyo
- Bristol Myers Squibb
- sanofi-aventis
- American College of Cardiology Foundation
- Equity
- Health Outcomes Sciences
Background The Affordable Care Act creates financial incentives for hospitals to minimize readmissions shortly after discharge for several conditions, with percutaneous coronary intervention (PCI) to be a target in 2015. We aimed to develop and validate prediction models to assist clinicians and hospitals in identifying patients at highest risk for 30-day readmission after PCI. Methods and Results We identified all readmissions within 30 days of discharge after PCI in nonfederal hospitals in Massachusetts between October 1, 2005, and September 30, 2008. Within a two-thirds random sample (Developmental cohort), we developed 2 parsimonious multivariable models to predict all-cause 30-day readmission, the first incorporating only variables known before cardiac catheterization (pre-PCI model), and the second incorporating variables known at discharge (Discharge model). Models were validated within the remaining one-third sample (Validation cohort), and model discrimination and calibration were assessed. Of 36060 PCI patients surviving to discharge, 3760 (10.4%) patients were readmitted within 30 days. Significant pre-PCI predictors of readmission included age, female sex, Medicare or State insurance, congestive heart failure, and chronic kidney disease. Post-PCI predictors of readmission included lack of -blocker prescription at discharge, post-PCI vascular or bleeding complications, and extended length of stay. Discrimination of the pre-PCI model (C-statistic=0.68) was modestly improved by the addition of post-PCI variables in the Discharge model (C-statistic=0.69; integrated discrimination improvement, 0.009; P<0.001). Conclusions These prediction models can be used to identify patients at high risk for readmission after PCI and to target high-risk patients for interventions to prevent readmission.
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