Abstract

Background

The simplified HOSPITAL score is an easy-to-use prediction model to identify patients at high risk of 30-day readmission before hospital discharge. An earlier stratification of this risk would allow more preparation time for transitional care interventions.

Objective

To assess whether the simplified HOSPITAL score would perform similarly by using hemoglobin and sodium level at the time of admission instead of discharge.

Design

Prospective national multicentric cohort study.

Participants

In total, 934 consecutively discharged medical inpatients from internal general services.

Main Measures

We measured the composite of the first unplanned readmission or death within 30 days after discharge of index admission and compared the performance of the simplified score with lab at discharge (simplified HOSPITAL score) and lab at admission (early HOSPITAL score) according to their discriminatory power (Area Under the Receiver Operating characteristic Curve (AUROC)) and the Net Reclassification Improvement (NRI).

Key Results

During the study period, a total of 3239 patients were screened and 934 included. In total, 122 (13.2%) of them had a 30-day unplanned readmission or death. The simplified and the early versions of the HOSPITAL score both showed very good accuracy (Brier score 0.11, 95%CI 0.10–0.13). Their AUROC were 0.66 (95%CI 0.60–0.71), and 0.66 (95%CI 0.61–0.71), respectively, without a statistical difference (p value 0.79). Compared with the model at discharge, the model with lab at admission showed improvement in classification based on the continuous NRI (0.28; 95%CI 0.08 to 0.48; p value 0.004).

Conclusion

The early HOSPITAL score performs, at least similarly, in identifying patients at high risk for 30-day unplanned readmission and allows a readmission risk stratification early during the hospital stay. Therefore, this new version offers a timely preparation of transition care interventions to the patients who may benefit the most.

Topic

JGIM

Author Descriptions

Division of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Philippe Mathys MD, Drahomir Aujesky MD, MSc & Jacques D. Donzé MD, MSc

Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
Philippe Mathys MD

CTU Bern, University of Bern, Bern, Switzerland
Lukas Bütikofer PhD

Division of Internal Medicine, Centre Hospitalier de Bienne, Bienne, Switzerland
Daniel Genné MD

University Center of Internal Medicine, Cantonal Hospital Baselland and University of Basel, Liestal, Switzerland
Jörg D. Leuppi MD, PhD

Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
Marco Mancinetti MD, MME

Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
Marco Mancinetti MD, MME

Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
Gregor John MD & Jacques D. Donzé MD, MSc

University of Geneva, Geneva, Switzerland
Gregor John MD

Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Jacques D. Donzé MD, MSc

Division of General Internal Medicine, CHUV, Lausanne University, Lausanne, Switzerland
Jacques D. Donzé MD, MSc

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