Simplified HOSPITAL score predicts 30-day readmissions


Clinical Question: Will a simplified HOSPITAL score accurately predict 30-day readmissions?

Background: Hospital readmissions stress patients and health care systems. Interventions to prevent avoidable readmissions are complex and expensive. The HOSPITAL score predicts 30-day readmissions which may help direct resources toward high risk patients.

Dr. Rebecca Helfrich is an assistant professor in the University of Kentucky division of hospital medicine.

Dr. Rebecca Helfrich

Study Design: A retrospective study.

Setting: Nine hospitals in four countries.

Synopsis: The HOSPITAL score was simplified by removing the procedure variable, expanding the oncology criteria to include a diagnosis of cancer, and dividing patients into high and low risk groups. The simplified HOSPITAL score was used to predict avoidable readmissions of 117,065 patients from nine hospitals. Readmission rates predicted by the simplified HOSPITAL score matched observed outcomes with a sensitivity of 94% and specificity of 73%. Its discriminatory power was comparable with the original HOSPITAL score.

This was a robust study of medical patients but may not be generalizable to surgical patients. The score does not include patients’ socioeconomic status or support systems. It also cannot indicate what type of intervention may prevent readmissions.

Bottom Line: The simplified HOSPITAL score accurately predicts avoidable 30-day readmission rates.

Citation: Aubert CE, Schnipper JL, Williams MV, et al. Simplification of the HOSPITAL score for predicting 30-day readmissions. BMJ Qual Saf. Published online first. 17 Apr 2017. doi: 10.1136/bmjqs-2016-006239.

Dr. Helfrich is an assistant professor in the University of Kentucky division of hospital medicine.

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