title: Accuracy of Prospective Predictions of 30-Day Hospital Readmission.
abstract: OBJECTIVE
  This study examined how accurately inpatient case managers predicted 30-day readmission and whether objective patient characteristics improved prediction accuracy.
  
  
  METHODS
  In this prospective study, inpatient case managers at a psychiatric hospital rated their concern (1, not concerned; 5, very concerned) about readmission after discharge of 282 privately insured patients. Sensitivity and specificity of the ratings were calculated. Logistic regression identified whether patient characteristics that could affect 30-day readmission improved prediction accuracy.
  
  
  RESULTS
  Concern levels ≥3 yielded 86% sensitivity, 37% specificity, and a positive predictive value (PPV) of 13%; levels ≥4 yielded 39% sensitivity, 78% specificity, and a PPV of 17%. Concern level independently predicted readmission; appointments within seven days postdischarge further improved model accuracy (p=.03) (area under the curve=.67, 95% confidence interval=.58-.78).
  
  
  CONCLUSIONS
  Although not highly accurate, case manager concern identified some patients at higher risk of 30-day readmission. Appointments within seven days of discharge improved prediction accuracy.
authors.affiliation: The authors are with the Department of Psychiatry, McLean Hospital, Belmont, Massachusetts (e-mail: mnreddy@partners.org ). Dr. Fitzmaurice is also with the Department of Biostatistics, Harvard School of Public Health, Boston. Dr. Busch is also with the Department of Psychiatry, Harvard Medical School, Boston.
authors.forename: Maya
authors.initials: M
authors.lastname: Reddy
authors.affiliation: The authors are with the Department of Psychiatry, McLean Hospital, Belmont, Massachusetts (e-mail: mnreddy@partners.org ). Dr. Fitzmaurice is also with the Department of Biostatistics, Harvard School of Public Health, Boston. Dr. Busch is also with the Department of Psychiatry, Harvard Medical School, Boston.
authors.forename: Susan
authors.initials: S
authors.lastname: Schneiders-Rice
authors.affiliation: The authors are with the Department of Psychiatry, McLean Hospital, Belmont, Massachusetts (e-mail: mnreddy@partners.org ). Dr. Fitzmaurice is also with the Department of Biostatistics, Harvard School of Public Health, Boston. Dr. Busch is also with the Department of Psychiatry, Harvard Medical School, Boston.
authors.forename: Casey
authors.initials: C
authors.lastname: Pierce
authors.affiliation: The authors are with the Department of Psychiatry, McLean Hospital, Belmont, Massachusetts (e-mail: mnreddy@partners.org ). Dr. Fitzmaurice is also with the Department of Biostatistics, Harvard School of Public Health, Boston. Dr. Busch is also with the Department of Psychiatry, Harvard Medical School, Boston.
authors.forename: Garrett
authors.initials: G
authors.lastname: Fitzmaurice
authors.affiliation: The authors are with the Department of Psychiatry, McLean Hospital, Belmont, Massachusetts (e-mail: mnreddy@partners.org ). Dr. Fitzmaurice is also with the Department of Biostatistics, Harvard School of Public Health, Boston. Dr. Busch is also with the Department of Psychiatry, Harvard Medical School, Boston.
authors.forename: Alisa
authors.initials: A
authors.lastname: Busch
mesh_terms: D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data*; D019540:Area Under Curve; D019090:Case Management; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000534:rehabilitation*; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D013334:Students / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation; D055815:Young Adult