Vol. 148 No. 1920 (2018)
External validation of the 80+ score and comparison with three clinical scores identifying patients at least 75 years old at risk of unplanned readmission within 30 days after discharge
- Camille Schwab
- Alexis Le Moigne
- Christine Fernandez
- Pierre Durieux
- Brigitte Sabatier
- Virginie Korb-Savoldelli
AIM OF THE STUDY
A potentially avoidable readmission is an unplanned readmission occurring within 30 days of discharge. As 20% of hospitalised elderly patients are rehospitalised as an unplanned readmission, it is necessary to identify with a clinical score those patients who are at risk of readmission and need discharge interventions as a priority. The main objective of this study was to externally validate and compare the 80+ score with the three other scores predicting the risk of unplanned readmission.
We conducted a retrospective case-control study using a clinical data warehouse. The study included patients hospitalised between 1 September 2014 and 31 October 2015 in an 800-bed university hospital. We included patients aged 75 and over. Cases were readmitted at the emergency department within 30 days after the index discharge. Controls were not readmitted as an emergency within 30 days. Four clinical scores (80+ score, LACE index, HOSPITAL score, TRST) were externally validated. Discrimination of the scores was assessed by calculating the area under the receiver operating characteristic curves (AUC). Calibration was assessed with a Hosmer-Lemeshow χ2 test.
We included 438 patients. For discrimination, the 80+ score, the LACE index, the HOSPITAL score and the TRST had AUCs of 0.506 (95% confidence interval [CI] 0.413–0.546), 0.534 (95% CI 0.459–0.591, 0.517 (95% CI 0.466–0.598) and 0.589 (95% CI 0.524–0.654), respectively. The Hosmer-Lemeshow χ2 tests had p-values of 0.44, 0.43, 0.11 and 0.49, respectively.
In our study, the 80+ score was externally validated and showed less favourable discrimination than the three other scores in this population.
- Halfon P, Eggli Y, van Melle G, Chevalier J, Wasserfallen JB, Burnand B. Measuring potentially avoidable hospital readmissions. J Clin Epidemiol. 2002;55(6):573–87. doi:.https://doi.org/10.1016/S0895-4356(01)00521-2
- Khan A, Malone ML, Pagel P, Vollbrecht M, Baumgardner DJ. An electronic medical record-derived real-time assessment scale for hospital readmission in the elderly. WMJ. 2012;111(3):119–23.
- van Galen LS, Brabrand M, Cooksley T, van de Ven PM, Merten H, So RK, et al.; Safer@home consortium. Patients’ and providers’ perceptions of the preventability of hospital readmission: a prospective, observational study in four European countries. BMJ Qual Saf. 2017;26(12):958–69. doi:.https://doi.org/10.1136/bmjqs-2017-006645
- van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ. Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011;183(7):E391–402. doi:.https://doi.org/10.1503/cmaj.101860
- Arendts G, Fitzhardinge S, Pronk K, Donaldson M, Hutton M, Nagree Y. The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study. BMC Geriatr. 2012;12(1):8. doi:.https://doi.org/10.1186/1471-2318-12-8
- Sager MA, Franke T, Inouye SK, Landefeld CS, Morgan TM, Rudberg MA, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med. 1996;156(6):645–52. doi:.https://doi.org/10.1001/archinte.1996.00440060067008
- Cloonan P, Wood J, Riley JB. Reducing 30-day readmissions: health literacy strategies. J Nurs Adm. 2013;43(7-8):382–7. doi:.https://doi.org/10.1097/NNA.0b013e31829d6082
- Haute Autorité de Santé. Comment réduire le risque de réhospitalisations évitables des personnes âgées? 2013. Available from: https://www.has-sante.fr/portail/jcms/c_1602735/fr/comment-reduire-les-rehospitalisations-evitables-des-personnes-agees.
- Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, et al. Risk prediction models for hospital readmission: a systematic review. JAMA. 2011;306(15):1688–98. doi:.https://doi.org/10.1001/jama.2011.1515
- van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551–7. doi:.https://doi.org/10.1503/cmaj.091117
- Donzé JD, Williams MV, Robinson EJ, Zimlichman E, Aujesky D, Vasilevskis EE, et al. International Validity of the HOSPITAL Score to Predict 30-Day Potentially Avoidable Hospital Readmissions. JAMA Intern Med. 2016;176(4):496–502. doi:.https://doi.org/10.1001/jamainternmed.2015.8462
- Meldon SW, Mion LC, Palmer RM, Drew BL, Connor JT, Lewicki LJ, et al. A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med. 2003;10(3):224–32. doi:.https://doi.org/10.1111/j.1553-2712.2003.tb01996.x
- Alassaad A, Melhus H, Hammarlund-Udenaes M, Bertilsson M, Gillespie U, Sundström J. A tool for prediction of risk of rehospitalisation and mortality in the hospitalised elderly: secondary analysis of clinical trial data. BMJ Open. 2015;5(2):e007259. doi:.https://doi.org/10.1136/bmjopen-2014-007259
- Bonnet-Zamponi D, d’Arailh L, Konrat C, Delpierre S, Lieberherr D, Lemaire A, et al.; Optimization of Medication in AGEd study group. Drug-related readmissions to medical units of older adults discharged from acute geriatric units: results of the Optimization of Medication in AGEd multicenter randomized controlled trial. J Am Geriatr Soc. 2013;61(1):113–21. doi:.https://doi.org/10.1111/jgs.12037
- Collins GS, Reitsma JB, Altman DG, Moons KGM. Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement. BMJ. 2015;350(jan07 4):g7594. doi:.https://doi.org/10.1136/bmj.g7594
- Schwab C, Korb-Savoldelli V, Escudie JB, Fernandez C, Durieux P, Saint-Jean O, et al. Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse. J Clin Pharm Ther. 2018. doi:.https://doi.org/10.1111/jcpt.12670
- Collins GS, Ogundimu EO, Altman DG. Sample size considerations for the external validation of a multivariable prognostic model: a resampling study. Stat Med. 2016;35(2):214–26. doi:.https://doi.org/10.1002/sim.6787
- Donzé J, Aujesky D, Williams D, Schnipper JL. Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med. 2013;173(8):632–8. doi:.https://doi.org/10.1001/jamainternmed.2013.3023
- Cotter PE, Bhalla VK, Wallis SJ, Biram RWS. Predicting readmissions: poor performance of the LACE index in an older UK population. Age Ageing. 2012;41(6):784–9. doi:.https://doi.org/10.1093/ageing/afs073
- Aubert CE, Folly A, Mancinetti M, Hayoz D, Donzé J. Prospective validation and adaptation of the HOSPITAL score to predict high risk of unplanned readmission of medical patients. Swiss Med Wkly. 2016;146:w14335.
- Cooksley T, Nanayakkara PWB, Nickel CH, Subbe CP, Kellett J, Kidney R, et al.; safer@home consortium. Readmissions of medical patients: an external validation of two existing prediction scores. QJM. 2016;109(4):245–8. doi:.https://doi.org/10.1093/qjmed/hcv130
- Pedersen MK, Meyer G, Uhrenfeldt L. Risk factors for acute care hospital readmission in older persons in Western countries: a systematic review. JBI Database Syst Rev Implement Reports. 2017;15(2):454–85.
- Laroche M-L, Bouthier F, Merle L, Charmes J-P. Médicaments potentiellement inappropriés aux personnes âgées : intérêt d’une liste adaptée à la pratique médicale française [Potentially inappropriate medications in the elderly: a list adapted to French medical practice]. Rev Med Interne. 2009;30(7):592–601. doi:.https://doi.org/10.1016/j.revmed.2008.08.010
- Pohl-Dernick K, Meier F, Maas R, Schöffski O, Emmert M. Potentially inappropriate medication in the elderly in Germany: an economic appraisal of the PRISCUS list. BMC Health Serv Res. 2016;16(1):109. doi:.https://doi.org/10.1186/s12913-016-1366-x
- American Geriatrics Society 2015 Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. J Am Geriatr Soc. 2015;63(11):2227–46. doi:.https://doi.org/10.1111/jgs.13702
- Hagstrom K, Nailor M, Lindberg M, Hobbs L, Sobieraj DM. Association between potentially inappropriate medication use in elderly adults and hospital-related outcomes. J Am Geriatr Soc. 2015;63(1):185–6. doi:.https://doi.org/10.1111/jgs.13229
- Pavon JM, Zhao Y, McConnell E, Hastings SN. Identifying risk of readmission in hospitalized elderly adults through inpatient medication exposure. J Am Geriatr Soc. 2014;62(6):1116–21. doi:.https://doi.org/10.1111/jgs.12829