title: Assessing the Performance of a Modified LACE Index (LACE-rt) to Predict Unplanned Readmission After Discharge in a Community Teaching Hospital.
abstract: BACKGROUND
  The LACE index was designed to predict early death or unplanned readmission after discharge from hospital to the community. However, implementing the LACE tool in real time in a teaching hospital required practical unavoidable modifications.
  
  
  OBJECTIVE
  The purpose of this study was to validate the implementation of a modified LACE index (LACE-rt) and test its ability to predict readmission risk using data in a hospital setting.
  
  
  METHODS
  Data from the Canadian Institute for Health Information's Discharge Abstract Database (DAD), the National Ambulatory Care Reporting System (NACRS), and the hospital electronic medical record for one large community hospital in Toronto, Canada, were used in this study. A total of 3855 admissions from September 2013 to July 2014 were analyzed (N=3855) using descriptive statistics, regression analysis, and receiver operating characteristic analysis. Prospectively collected data from DAD and NACRS were linked to inpatient data.
  
  
  RESULTS
  The LACE-rt index was a fair test to predict readmission risk (C statistic=.632). A LACE-rt score of 10 is a good threshold to differentiate between patients with low and high readmission risk; the high-risk patients are 2.648 times more likely to be readmitted than those at low risk. The introduction of LACE-rt had no significant impact on readmission reduction.
  
  
  CONCLUSIONS
  The LACE-rt is a fair tool for identifying those at risk of readmission. A collaborative cross-sectoral effort that includes those in charge of providing community-based care is needed to reduce readmission rates. An eHealth solution could play a major role in streamlining this collaboration.
authors.affiliation: Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada.
authors.forename: Christo
authors.identifier: http://orcid.org/0000-0001-6287-3438
authors.initials: C
authors.lastname: El Morr
authors.affiliation: Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada.
authors.forename: Liane
authors.identifier: http://orcid.org/0000-0002-4436-9198
authors.initials: L
authors.lastname: Ginsburg
authors.affiliation: Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada.
authors.forename: Seungree
authors.identifier: http://orcid.org/0000-0003-1705-3849
authors.initials: S
authors.lastname: Nam
authors.affiliation: North York General Hospital, Medicine, North York General Hospital, Toronto, ON, Canada.
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-5450-9449
authors.initials: S
authors.lastname: Woollard
keywords: cost savings; eHealth; health services; hospital readmissions; medical informatics; patient readmission; quality improvement; quality of health care