title: Preparedness for hospital discharge and prediction of readmission.
abstract: Patients' self-reported preparedness for discharge has been shown to predict readmission. It is unclear what differences exist in the predictive abilities of 2 available discharge preparedness measures. To address this gap, we conducted a comparison of these measures.
  
  
  
  Adults hospitalized for cardiovascular diagnoses were enrolled in a prospective cohort.
  
  
  
  Two patient-reported preparedness measures assessed during postdischarge calls: the 11-item Brief Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services (B-PREPARED) and the 3-item Care Transitions Measure (CTM-3). Cox proportional hazard models analyzed the relationship between preparedness and time to first readmission or death at 30 and 90 days, adjusted for readmission risk using the administrative database-derived Length of stay, Acuity, Comorbidity, and Emergency department use (LACE) index and other covariates.
  
  
  
  Median preparedness scores were: B-PREPARED 21 (interquartile range [IQR] 18-22) and CTM-3 77.8 (IQR 66.7-100). In individual Cox models, a 4-point increase in B-PREPARED score was associated with a 16% decrease in time to readmission or death at 30 and 90 days. A 10-point increase in CTM-3 score was not associated with readmission or death at 30 days, but was associated with a 6% decrease in readmission or death at 90 days. In models with both preparedness scores, B-PREPARED retained an association with readmission or death at both 30 and 90 days. However, neither preparedness score was as strong a predictor as the LACE index when all were included in the model predicting 30- and 90-day readmission or death.
  
  
  
  The B-PREPARED score was more strongly associated with readmission or death than the more widely adopted CTM-3, but neither predicted readmission as well as the LACE index. Journal of Hospital Medicine 2016;11:603-609. © 2016 Society of Hospital Medicine.
authors.affiliation: Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee. amanda.s.mixon@vanderbilt.edu.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee. amanda.s.mixon@vanderbilt.edu.|Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee. amanda.s.mixon@vanderbilt.edu.|Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee. amanda.s.mixon@vanderbilt.edu.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Mixon
authors.affiliation: Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Goggins
authors.affiliation: Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Susan P
authors.initials: SP
authors.lastname: Bell
authors.affiliation: Department of Veterans Affairs, Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center, Nashville, Tennessee.|Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Eduard E
authors.initials: EE
authors.lastname: Vasilevskis
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Samuel
authors.initials: S
authors.lastname: Nwosu
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Schildcrout
authors.affiliation: Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee.|Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sunil
authors.initials: S
authors.lastname: Kripalani
mesh_terms: D002318:Cardiovascular Diseases; D015897:Comorbidity; D005260:Female; D005544:Forecasting; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011795:Surveys and Questionnaires