title: Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization.
abstract: Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk.
  
  
  METHODS
  HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated.
  
  
  RESULTS
  The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF.
  
  
  CONCLUSIONS
  Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment.
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Department of Biomedical Informatics, University of Utah, Salt Lake City, UT. Electronic address: benjamin.horne@imail.org.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Deborah
authors.initials: D
authors.lastname: Budge
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Masica
authors.affiliation: Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Lucy A
authors.initials: LA
authors.lastname: Savitz
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT.
authors.forename: José
authors.initials: J
authors.lastname: Benuzillo
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, TX.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Cantu
authors.affiliation: Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Alejandra
authors.initials: A
authors.lastname: Bradshaw
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Raymond O
authors.initials: RO
authors.lastname: McCubrey
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT.
authors.forename: Colleen A
authors.initials: CA
authors.lastname: Roberts
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Kismet D
authors.initials: KD
authors.lastname: Rasmusson
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT.
authors.forename: Rami
authors.initials: R
authors.lastname: Alharethi
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.affiliation: Institute for Healthcare Leadership, Intermountain Healthcare, Salt Lake City, UT; Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Brent C
authors.initials: BC
authors.lastname: James
authors.affiliation: Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT; Cardiology Division, Department of Internal Medicine, University of Utah, Salt Lake City, UT.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Lappé
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001639:Bicarbonates / Q000097:blood; D001806:Blood Urea Nitrogen; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use; D004906:Erythrocyte Count; D004909:Erythrocyte Indices; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy; D006400:Hematocrit; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007958:Leukocyte Count; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012737:Sex Factors; D012964:Sodium / Q000097:blood; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000925:Anticoagulants; D001639:Bicarbonates; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D010975:Platelet Aggregation Inhibitors; D014662:Vasoconstrictor Agents; D020097:Natriuretic Peptide, Brain; D012964:Sodium; D003404:Creatinine; D011188:Potassium