The HOSPITAL Score: A Potential to Help Avoid 30-Day Readmissions

Studies show that one in five Medicare beneficiaries returns to the hospital within 30 days of discharge at an annual cost of $18 billion to the program. More importantly, many of these readmissions are thought to be preventable with better care. As a result of this, in the fall of 2012, Medicare began to penalize hospitals with excessive hospital readmissions for heart attacks, congestive heart failure, and pneumonia. The aim of this study was to derive and internally validate a simple score to help identify high-risk patients.

Potentially avoidable 30-day hospital readmissions in medical patients

What they did:

Derive and internally validate a prediction model to help avoid 30-day hospital re-admissions in medical patients
Retrospective Cohort Study
Academic Medical Center in Boston
10,731 discharges (2/3 derivation and 1/3 internal validation)

Primary Outcomes:

Identify potentially avoidable 30-day readmissions

Results:

2,398/10,731 (22.3%) of discharges were followed by a 30-day readmission
879/10,731 (8.5%) of discharges were identified as avoidable
7 Independent factors identified (HOSPITAL Score):

Hospital Score - 30-day Avoidable Readmissions

Most common procedures: Chemotherapy infusion (8.8%), Biopsy (7.5%), Transfusion (7.1%), and Endoscopy (6.1%)
Score of 0-4 = Low Risk
Score of 5 – 6 = Intermediate Risk
Score >7 = High Risk

Limitations:

Did not track readmissions outside the hospital network
Post-discharge mortality was not tracked
HOSPITAL Score not externally validated

Conclusions:

This simple prediction model identifies before discharge the risk of potentially avoidable 30-day readmission in medical patients and who may need more intensive transitional care interventions

In My Opinion, How This Will Affect Your Practice:

Medicare will continue to penalize hospitals for high 30-day readmission rates, and the list of illnesses is likely to increase in the next few years
Using a simple score to help predict high-risk patients for 30-day readmission would be an efficient way to focus time and effort
An external validation still needs to be completed using The HOSPITAL Score before its implementation

Reference:

Donze J et al. Potentially Avoidable 30-Day Hospital Readmissions in Medical Patients: Derivation and Validation of a Prediction Model. JAMA Intern Med 2013 Apr; 173 (8): 632 – 638. PMID: 23529115

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Dr. Salim R. Rezaie is a physician at the University of Texas Health Science Center at San Antonio. He is double board-certified in Emergency Medicine and Internal Medicine.