title: Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model.
abstract: OBJECTIVE
  Because effective interventions to reduce hospital readmissions are often expensive to implement, a score to predict potentially avoidable readmissions may help target the patients most likely to benefit.
  
  
  OBJECTIVE
  To derive and internally validate a prediction model for potentially avoidable 30-day hospital readmissions in medical patients using administrative and clinical data readily available prior to discharge.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic medical center in Boston, Massachusetts.
  
  
  METHODS
  All patient discharges from any medical services between July 1, 2009, and June 30, 2010.
  
  
  METHODS
  Potentially avoidable 30-day readmissions to 3 hospitals of the Partners HealthCare network were identified using a validated computerized algorithm based on administrative data (SQLape). A simple score was developed using multivariable logistic regression, with two-thirds of the sample randomly selected as the derivation cohort and one-third as the validation cohort.
  
  
  RESULTS
  Among 10 731 eligible discharges, 2398 discharges (22.3%) were followed by a 30-day readmission, of which 879 (8.5% of all discharges) were identified as potentially avoidable. The prediction score identified 7 independent factors, referred to as the HOSPITAL score: h emoglobin at discharge, discharge from an o ncology service, s odium level at discharge, p rocedure during the index admission, i ndex t ype of admission, number of a dmissions during the last 12 months, and l ength of stay. In the validation set, 26.7% of the patients were classified as high risk, with an estimated potentially avoidable readmission risk of 18.0% (observed, 18.2%). The HOSPITAL score had fair discriminatory power (C statistic, 0.71) and had good calibration.
  
  
  CONCLUSIONS
  This simple prediction model identifies before discharge the risk of potentially avoidable 30-day readmission in medical patients. This score has potential to easily identify patients who may need more intensive transitional care interventions.
authors.affiliation: Division of General Medicine and Primary Care, Brigham andWomen’s Hospital, Boston,MA 02120, USA. jdonze@partners.org
authors.forename: Jacques
authors.initials: J
authors.lastname: Donzé
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.forename: Deborah
authors.initials: D
authors.lastname: Williams
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies