RT Journal Article
SR Electronic
T1 Simplification of the HOSPITAL score for predicting 30-day readmissions
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 799
OP 805
DO 10.1136/bmjqs-2016-006239
VO 26
IS 10
A1 Carole E Aubert
A1 Jeffrey L Schnipper
A1 Mark V Williams
A1 Edmondo J Robinson
A1 Eyal Zimlichman
A1 Eduard E Vasilevskis
A1 Sunil Kripalani
A1 Joshua P Metlay
A1 Tamara Wallington
A1 Grant S Fletcher
A1 Andrew D Auerbach
A1 Drahomir Aujesky
A1 Jacques D Donzé
YR 2017
UL http://qualitysafety.bmj.com/content/26/10/799.abstract
AB Objective The HOSPITAL score has been widely validated and accurately identifies high-risk patients who may mostly benefit from transition care interventions. Although this score is easy to use, it has the potential to be simplified without impacting its performance. We aimed to validate a simplified version of the HOSPITAL score for predicting patients likely to be readmitted.Design and setting Retrospective study in 9 large hospitals across 4 countries, from January through December 2011.Participants We included all consecutively discharged medical patients. We excluded patients who died before discharge or were transferred to another acute care facility.Measurements The primary outcome was any 30-day potentially avoidable readmission. We simplified the score as follows: (1) ‘discharge from an oncology division’ was replaced by ‘cancer diagnosis or discharge from an oncology division’; (2) ‘any procedure’ was left out; (3) patients were categorised into two risk groups (unlikely and likely to be readmitted). The performance of the simplified HOSPITAL score was evaluated according to its overall accuracy, its discriminatory power and its calibration.Results Thirty-day potentially avoidable readmission rate was 9.7% (n=11 307/117 065 patients discharged). Median of the simplified HOSPITAL score was 3 points (IQR 2–5). Overall accuracy was very good with a Brier score of 0.08 and discriminatory power remained good with a C-statistic of 0.69 (95% CI 0.68 to 0.69). The calibration was excellent when comparing the expected with the observed risk in the two risk categories.Conclusions The simplified HOSPITAL score has good performance for predicting 30-day readmission. Prognostic accuracy was similar to the original version, while its use is even easier. This simplified score may provide a good alternative to the original score depending on the setting.