Risk-adjustment models for heart failure patients' 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record.
Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure.



This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC).



A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08).



We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
Jacopo
J
Lenzi
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
Vera Maria
VM
Avaldi
Department of Surgery, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305-2200, USA.
Tina
T
Hernandez-Boussard
Department of Clinical Governance, Bologna Local Healthcare Authority, via Castiglione 29, 40124, Bologna, Italy.
Carlo
C
Descovich
Department of Programming and Control, Bologna Local Healthcare Authority, via Castiglione 29, 40124, Bologna, Italy.
Ilaria
I
Castaldini
Department of Cardiology, Bellaria Hospital, via Altura 3, 40139, Bologna, Italy.
Stefano
S
Urbinati
Department of Cardiology, Maggiore Hospital, Largo Nigrisoli 2, 40133, Bologna, Italy.
Giuseppe
G
Di Pasquale
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, via San Giacomo 12, 40126, Bologna, Italy.
Paola
P
Rucci
Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, via San Giacomo 12, 40126, Bologna, Italy. mariapia.fantini@unibo.it.
Maria Pia
MP
Fantini
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003625:Data Collection / Q000379:methods / Q000592:standards; D005260:Female; D006333:Heart Failure / Q000401:mortality*; D006753:Hospital Records / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020379:Risk Adjustment / Q000379:methods; D055815:Young Adult
Heart failure; Mortality; Readmissions; Risk-adjustment