title: Development and validation of a simple risk score to predict 30-day readmission after percutaneous coronary intervention in a cohort of medicare patients.
abstract: OBJECTIVE
  To develop a risk model that can be used to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge.
  
  
  BACKGROUND
  A high proportion of patients undergoing PCI are readmitted within 30 days of discharge.
  
  
  METHODS
  The sample comprised patients aged ≥65 years who underwent PCI at a CathPCI Registry®-participating hospital and could be linked with 100% Medicare fee-for-service claims between 01/2007 and 12/2009. The sample (n = 388,078) was randomly divided into risk score development (n = 193,899) and validation (n = 194,179) cohorts. We did not count as readmissions those associated with staged revascularization procedures. Multivariable logistic regression models using stepwise selection models were estimated to identify variables independently associated with all-cause 30-day readmission.
  
  
  RESULTS
  The mean 30-day readmission rates for the development (11.36%) and validation (11.35%) cohorts were similar. In total, 19 variables were significantly associated with risk of 30-day readmission (P < 0.05), and model c-statistics were similar in the development (0.67) and validation (0.66) cohorts. The simple risk score based on 14 variables identified patients at high and low risk of readmission. Patients with a score of ≥13 (15.4% of sample) had more than an 18.5% risk of readmission, while patients with a score ≤6 (41.9% of sample) had less than an 8% risk of readmission.
  
  
  CONCLUSIONS
  Among PCI patients, risk of readmission can be estimated using clinical factors present at the time of the procedure. This risk score may guide clinical decision-making and resource allocation for PCI patients at the time of hospital discharge. © 2016 Wiley Periodicals, Inc.
authors: Center for Outcomes Research and Evaluation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Karl E
authors: KE
authors: Minges
authors: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.|Health Research & Educational Trust, Chicago, Illinois.
authors: Jeph
authors: J
authors: Herrin
authors: Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Paul N
authors: PN
authors: Fiorilli
authors: Center for Outcomes Research and Evaluation, Yale School of Medicine, Yale-New Haven Hospital, New Haven, Connecticut.|Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors: Jeptha P
authors: JP
authors: Curtis
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
keywords: Medicare; health care outcomes; percutaneous coronary intervention; quality improvement; risk stratification