Hospital readmission in general medicine patients: a prediction model

Hasan, Omar; Meltzer, David O.; Shaykevich, Shimon A.; Bell, Chaim M.; Kaboli, Peter J.; Auerbach, Andrew D.; Wetterneck, Tosha B.; Arora, Vineet M.; Zhang, James; Schnipper, Jeffrey L.
March 2010
JGIM: Journal of General Internal Medicine;Mar2010, Vol. 25 Issue 3, p211
Academic Journal
journal article
Background: Previous studies of hospital readmission have focused on specific conditions or populations and generated complex prediction models.Objective: To identify predictors of early hospital readmission in a diverse patient population and derive and validate a simple model for identifying patients at high readmission risk.Design: Prospective observational cohort study.Patients: Participants encompassed 10,946 patients discharged home from general medicine services at six academic medical centers and were randomly divided into derivation (n = 7,287) and validation (n = 3,659) cohorts.Measurements: We identified readmissions from administrative data and 30-day post-discharge telephone follow-up. Patient-level factors were grouped into four categories: sociodemographic factors, social support, health condition, and healthcare utilization. We performed logistic regression analysis to identify significant predictors of unplanned readmission within 30 days of discharge and developed a scoring system for estimating readmission risk.Results: Approximately 17.5% of patients were readmitted in each cohort. Among patients in the derivation cohort, seven factors emerged as significant predictors of early readmission: insurance status, marital status, having a regular physician, Charlson comorbidity index, SF12 physical component score, >or=1 admission(s) within the last year, and current length of stay >2 days. A cumulative risk score of >or=25 points identified 5% of patients with a readmission risk of approximately 30% in each cohort. Model discrimination was fair with a c-statistic of 0.65 and 0.61 for the derivation and validation cohorts, respectively.Conclusions: Select patient characteristics easily available shortly after admission can be used to identify a subset of patients at elevated risk of early readmission. This information may guide the efficient use of interventions to prevent readmission.


Related Articles

  • Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study. Benzo, Roberto; Vickers, Kristin; Novotny, Paul J.; Tucker, Sharon; Hoult, Johanna; Neuenfeldt, Pamela; Connett, John; Lorig, Kate; McEvoy, Charlene // American Journal of Respiratory & Critical Care Medicine;9/15/2016, Vol. 194 Issue 6, p672 

    Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions.Objectives: To determine the effect...

  • Brief report: Resident recognition of low literacy as a risk factor in hospital readmission. Powell, Caroline K.; Kripalani, Sunil // JGIM: Journal of General Internal Medicine;Nov2005, Vol. 20 Issue 11, p1042 

    Background: Low literacy is associated with poor self-management of disease and increased hospitalization, yet few studies have explored the extent to which physicians consider literacy in their patient care.Objective: To examine trainee recognition of low literacy as a...

  • Cognitive-behavioural therapy v. structured care for medically unexplained symptoms: randomised controlled trial. Sumathipala, A.; Siribaddana, S.; Abeysingha, M. R. N.; Dewey, M.; Prince, M.; Mann, A. H.; De Silva, P // British Journal of Psychiatry;Jul2008, Vol. 193 Issue 1, p51 

    Background: A pilot trial in Sri Lanka among patients with medically unexplained symptoms revealed that cognitive-behavioural therapy (CBT) administered by a psychiatrist was efficacious.Aims: To evaluate CBT provided by primary care physicians in a comparison with...

  • Prediction of outcome following a first episode of schizophrenia. A follow-up study of Northwick Park first episode study subjects. Geddes, John; Mercer, Gavin; Frith, C. D.; MacMillan, Fiona; Owens, David G. C.; Johnstone, Eve C.; Geddes, J; Mercer, G; MacMillan, F; Owens, D G; Johnstone, E C // British Journal of Psychiatry;Nov94, Vol. 165, p664 

    Background: Although previous studies have attempted to identify predictors of outcome in schizophrenia, few have prospectively studied first episode patients for an adequate follow-up period.Method: The psychopathological predictors of outcome were investigated in a...

  • Biomarkers Predictive of Exacerbations in the SPIROMICS and COPDGene Cohorts. Keene, Jason D.; Jacobson, Sean; Kechris, Katerina; Kinney, Gregory L.; Foreman, Marilyn G.; Doerschuk, Claire M.; Make, Barry J.; Curtis, Jeffrey L.; Rennard, Stephen I.; Barr, R. Graham; Bleecker, Eugene R.; Kanner, Richard E.; Kleerup, Eric C.; Hansel, Nadia N.; Woodruff, Prescott G.; Han, MeiLan K.; Paine III, Robert; Martinez, Fernando J.; Bowler, Russell P.; O'Neal, Wanda K. // American Journal of Respiratory & Critical Care Medicine;2/15/2017, Vol. 195 Issue 4, p473 

    Rationale: Chronic obstructive pulmonary disease exacerbations are associated with disease progression, higher healthcare cost, and increased mortality. Published predictors of future exacerbations include previous exacerbation, airflow obstruction, poor overall health, home oxygen...

  • The impact of clinical trials on the use of hormone replacement therapy. A population-based study. Kim, Nancy; Gross, Cary; Curtis, Jeptha; Stettin, Glen; Wogen, Stephen; Choe, Nami; Krumholz, Harlan M. // JGIM: Journal of General Internal Medicine;Nov2005, Vol. 20 Issue 11, p1026 

    Background: The last 5 years of trial data demonstrate the ineffectiveness of hormone replacement therapy (HRT). The impact of these trials on age-specific HRT use, HRT discontinuation, and regional HRT variation has not been evaluated extensively.Objective: To...

  • Effect of student involvement on patient perceptions of ambulatory care visits: a randomized controlled trial. Gress, Todd W.; Flynn, John A.; Rubin, Haya R.; Simonson, Lisa; Sisson, Stephen; Thompson, Traci; Brancati, Frederick L. // JGIM: Journal of General Internal Medicine;Jun2002, Vol. 17 Issue 6, p420 

    Objective: To determine if patient satisfaction with ambulatory care visits differs when medical students participate in the visit.Design: Randomized controlled trial.Setting: Academic general internal medicine practice.Participants:...

  • Perceived helpfulness of physicians' communication behavior and breast cancer patients' level of trust over time. Arora, Neeraj K.; Gustafson, David H. // JGIM: Journal of General Internal Medicine;Feb2009, Vol. 24 Issue 2, p252 

    Objective: We evaluated the association between physicians' communication behavior and breast cancer patients' trust in their physicians.Design: Longitudinal survey conducted at baseline, 2-month, and 5-month follow-up during first year of diagnosis.Participants:...

  • Maintenance of Weight Loss After Initiation of Nutrition Training: A Randomized Trial. Voils, Corrine I; Olsen, Maren K; Gierisch, Jennifer M; McVay, Megan A; Grubber, Janet M; Gaillard, Leslie; Bolton, Jamiyla; Maciejewski, Matthew L; Strawbridge, Elizabeth; Yancy, William S Jr // Annals of Internal Medicine;2/21/2017, Vol. 166 Issue 4, pN.PAG 

    Background: Weight regain after successful weight loss interventions is common.Objective: To establish the efficacy of a weight loss maintenance program compared with usual care in obese adults.Design: 2-group, parallel, randomized trial stratified by...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics