Predicting 30-Day All-Cause Readmission Risk for Subjects Admitted With Pneumonia at the Point of Care.
BACKGROUND: The pneumonia 30-d readmission rate has been endorsed by the National Quality Forum as a quality metric. Hospital readmissions can potentially be lowered by improving inhospital care, transitions of care, and post-discharge disease management programs. The purpose of this study was to cr...
| Publicado en: | Respiratory Care Vol. 63; no. 1; pp. 43 - 50 |
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| Autores principales: | , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Mary Ann Liebert, Inc.
Jan2018
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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=126845370&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 126845370 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00201324 4GG jtl: Respiratory Care issn: 00201324 maglogo: N pubinfo: dt: Jan2018 vid: 63 iid: 1 pid: 1365 pub: Mary Ann Liebert, Inc. place: New Rochelle, New York artinfo: ui: 126845370 126845370 126845370 10.4187/respcare.05719 126845370 ppf: 43 ppct: 7 formats: fmt: @attributes: type: P tig: atl: Predicting 30-Day All-Cause Readmission Risk for Subjects Admitted With Pneumonia at the Point of Care. aug: au: Hatipoğlu, Umur Wells, Brian J. Chagin, Kevin Joshi, Dhruv Milinovich, Alex Rothberg, Michael B. affil: Respiratory Institute, Medicine Institute, Cleveland Clinic, Cleveland, Ohio sug: subj: Readmission Risk Assessment Pneumonia Human Clinical Indicators Patient Discharge Hospitalization Ohio Electronic Health Records Descriptive Statistics Aged Confidence Intervals Narcotics Albumins Blood International Normalized Ratio Blood Urea Nitrogen P-Value United States Centers for Medicare and Medicaid Services Comparative Studies After Care Adolescence Adult Data Analysis Software ROC Curve Middle Age Comorbidity Probability Calibration Retrospective Design Aged: 65+ years Adolescent: 13-18 years Adult: 19-44 years Middle Aged: 45-64 years ab: BACKGROUND: The pneumonia 30-d readmission rate has been endorsed by the National Quality Forum as a quality metric. Hospital readmissions can potentially be lowered by improving inhospital care, transitions of care, and post-discharge disease management programs. The purpose of this study was to create an accurate prediction model for determining the risk of 30-d readmission at the point of discharge. METHODS: The model was created using a data set of 1,295 hospitalizations at the Cleveland Clinic Main Campus with pneumonia over 3 y. Candidate variables were limited to structured variables available in the electronic health record. The final model was compared with the Centers for Medicare and Medicaid Services (CMS) model among subjects 65 y of age and older (n = 628) and was externally validated. RESULTS: Three hundred thirty subjects (25%) were readmitted within 30 d. The final model contained 13 variables and had a bias-corrected C statistic of 0.74 (95% CI 0.71- 0.77). Number of admissions in the prior 6 months, opioid prescription, serum albumin during the first 24 h, international normalized ratio and blood urea nitrogen during the last 24 h were the predictor variables with the greatest weight in the model. In terms of discriminative performance, the Cleveland Clinic model outperformed the CMS model on the validation cohort (C statistic 0.69 vs 0.60, P = .042). CONCLUSIONS: The proposed risk prediction model performed better than the CMS model. Accurate readmission risk prediction at the point of discharge is feasible and can potentially be used to focus post-acute care interventions in a high-risk group of patients. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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