Enhancing the Prediction of 30-Day Readmission After Percutaneous Coronary Intervention Using Data Extracted by Querying of the Electronic Health Record.
BACKGROUND
Early readmission after percutaneous coronary intervention is an important quality metric, but prediction models from registry data have only moderate discrimination. We aimed to improve ability to predict 30-day readmission after percutaneous coronary intervention from a previously validated registry-based model.


RESULTS
We matched readmitted to non-readmitted patients in a 1:2 ratio by risk of readmission, and extracted unstructured and unconventional structured data from the electronic medical record, including need for medical interpretation, albumin level, medical nonadherence, previous number of emergency department visits, atrial fibrillation/flutter, syncope/presyncope, end-stage liver disease, malignancy, and anxiety. We assessed differences in rates of these conditions between cases/controls, and estimated their independent association with 30-day readmission using logistic regression conditional on matched groups. Among 9288 percutaneous coronary interventions, we matched 888 readmitted with 1776 non-readmitted patients. In univariate analysis, cases and controls were significantly different with respect to interpreter (7.9% for cases and 5.3% for controls; P=0.009), emergency department visits (1.12 for cases and 0.77 for controls; P<0.001), homelessness (3.2% for cases and 1.6% for controls; P=0.007), anticoagulation (33.9% for cases and 22.1% for controls; P<0.001), atrial fibrillation/flutter (32.7% for cases and 28.9% for controls; P=0.045), presyncope/syncope (27.8% for cases and 21.3% for controls; P<0.001), and anxiety (69.4% for cases and 62.4% for controls; P<0.001). Anticoagulation, emergency department visits, and anxiety were independently associated with readmission.


CONCLUSIONS
Patient characteristics derived from review of the electronic health record can be used to refine risk prediction for hospital readmission after percutaneous coronary intervention.
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Jason H
JH
Wasfy
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Gaurav
G
Singal
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Cashel
C
O'Brien
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Daniel M
DM
Blumenthal
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Kevin F
KF
Kennedy
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Jordan B
JB
Strom
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
John A
JA
Spertus
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Laura
L
Mauri
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.).
Sharon-Lise T
SL
Normand
From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.W., C.O'B., D.M.B., R.W.Y.), Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (L.M.), Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (G.S.), Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (J.B.S.), Saint Luke's Mid America Heart Institute/UMKC, Kansas City, MO (K.F.K., J.A.S.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA (S.-L.T.N.). ryeh@partners.org.
Robert W
RW
Yeh
D000368:Aged; D057286:Electronic Health Records; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D010359:Patient Readmission / Q000639:trends*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D011785:Quality Assurance, Health Care / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
bioinformatics; health policy and outcomes research; percutaneous coronary intervention; performance measures; readmission