Applicability of a previously validated readmission predictive index in medical patients in Singapore: a retrospective study.
BACKGROUND
Hospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management. Several models to identify patients at risk of unplanned readmissions have been developed in Western countries, but little is known about their performance in other countries. This paper reports the possible utility of one such model developed in Canada, the LACE index, in patients in a tertiary hospital in Singapore.


METHODS
We used administrative data from Singapore General Hospital for patients admitted between 1st January 2006 and 31st December 2010. Data such as demographic and clinical data including disease codes were extracted. The patient cohort was divided into two groups with a LACE index of 10 as the cutoff. Multivariate logistic regression analysis models were used to compare the outcomes between the two groups of patients with adjustment for age, sex, ethnicity, year of discharge, intensive care unit admission, and admission ward class.


RESULTS
Overall, 127 550 patients were eligible for analysis. Patients with a LACE index ≥ 10 had a higher risk of 30-day unplanned readmission after index discharge (odds ratio [OR]: 4.37; 95% confidence interval [CI]: 4.18-4.57). After adjustment, the risk remained significant (OR: 4.88; 95% CI: CI 4.57-5.22). The C-statistic for the adjusted model was 0.70 (P < 0.001). Similar results were shown for 90-day unplanned readmission and emergency visits after the same adjustment.


CONCLUSIONS
The use of the LACE index may have significant application in identifying medical patients at high risk of readmission and visits to the Emergency Department in Singapore.
Department of Family Medicine and Continuing Care, Singapore General Hospital, Bowyer Block A, Level 2, Outram Road, 169608 Singapore, Singapore. tan.shu.yun@sgh.com.sg.
Shu Yun
SY
Tan
Lian Leng
LL
Low
Yong
Y
Yang
Kheng Hock
KH
Lee
D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012846:Singapore / Q000453:epidemiology