Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance.
BACKGROUND: Existing models developed to predict 30 days readmissions for pneumonia lack discriminative ability. We attempted to increase model performance with the addition of variables found to be of benefit in other studies. METHODS: From 133,368 admissions to a tertiary-care hospital from Januar...
| Publicado en: | Respiratory Care Vol. 59; no. 2; pp. 199 - 209 |
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| Autores principales: | , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Feb2014
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104015729&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104015729 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Feb2014 vid: 59 iid: 2 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 104015729 94080510 10.4187/respcare.02563 NLM23942750 104015729 ppf: 199 ppct: 10 formats: fmt: @attributes: type: P tig: atl: Prediction of Pneumonia 30-Day Readmissions: A Single-Center Attempt to Increase Model Performance. aug: au: Mather, Jeffrey F. Fortunato, Gilbert J. Ash, Jenifer L. Davis, Michael J. Kumar, Ajay affil: Department of Research Administration, Hartford Hospital, Hartford, Connecticut sug: subj: Pneumonia Complications Hospitalization Readmission Risk Assessment Socioeconomic Factors Health Resource Utilization Depression Human Prospective Studies Record Review Logistic Regression Female Male Confidence Intervals Odds Ratio United States Centers for Medicare and Medicaid Services Retrospective Design Nonexperimental Studies Academic Medical Centers Connecticut Aged Aged, 80 and Over Descriptive Statistics Chi Square Test T-Tests Multiple Logistic Regression Data Analysis Software Kaplan-Meier Estimator Multivariate Analysis Goodness of Fit Chi Square Test ROC Curve Aged: 65+ years Aged, 80 & over Female Male ab: BACKGROUND: Existing models developed to predict 30 days readmissions for pneumonia lack discriminative ability. We attempted to increase model performance with the addition of variables found to be of benefit in other studies. METHODS: From 133,368 admissions to a tertiary-care hospital from January 2009 to March 2012, the study cohort consisted of 956 index admissions for pneumonia, using the Centers for Medicare and Medicaid Services definition. We collected variables previously reported to be associated with 30-day all-cause readmission, including vital signs, comorbidities, laboratory values, demographics, socioeconomic indicators, and indicators of hospital utilization. Separate logistic regression models were developed to identify the predictors of all-cause hospital readmission 30 days after discharge from the index pneumonia admission for pneumonia-related readmissions, and for pneumonia-unrelated readmissions. RESULTS: Of the 965 index admissions for pneumonia, 148 (15.5%) subjects were readmitted within 30 days. The variables in the multivariate-model that were significantly associated with 30-day all-cause readmission were male sex (odds ratio 1.59, 95% CI 1.03-2.45), 3 or more previous admissions (odds ratio 1.84, 95% CI 1.22-2.78), chronic lung disease (odds ratio 1.63, 95% CI 1.07-2.48), cancer (odds ratio 2.18, 95% CI 1.24 -3.84), median income < $43,000 (odds ratio 1.82, 95% CI 1.18 -2.81), history of anxiety or depression (odds ratio 1.62, 95% CI 1.04 -2.52), and hematocrit < 30% (odds ratio 1.86, 95% CI 1.07-3.22). The model performance, as measured by the C statistic, was 0.71 (0.66-0.75), with minimal optimism according to bootstrap re-sampling (optimism corrected C statistic 0.67). CONCLUSIONS: The addition of socioeconomic status and healthcare utilization variables significantly improved model performance, compared to the model using only the Centers for Medicare and Medicaid Services variables. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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