title: FAM-FACE-SG: a score for risk stratification of frequent hospital admitters.
abstract: An accurate risk stratification tool is critical in identifying patients who are at high risk of frequent hospital readmissions. While 30-day hospital readmissions have been widely studied, there is increasing interest in identifying potential high-cost users or frequent hospital admitters. In this study, we aimed to derive and validate a risk stratification tool to predict frequent hospital admitters.
  
  
  
  We conducted a retrospective cohort study using the readily available clinical and administrative data from the electronic health records of a tertiary hospital in Singapore. The primary outcome was chosen as three or more inpatient readmissions within 12 months of index discharge. We used univariable and multivariable logistic regression models to build a frequent hospital admission risk score (FAM-FACE-SG) by incorporating demographics, indicators of socioeconomic status, prior healthcare utilization, markers of acute illness burden and markers of chronic illness burden. We further validated the risk score on a separate dataset and compared its performance with the LACE index using the receiver operating characteristic analysis.
  
  
  
  Our study included 25,244 patients, with 70% randomly selected patients for risk score derivation and the remaining 30% for validation. Overall, 4,322 patients (17.1%) met the outcome. The final FAM-FACE-SG score consisted of nine components: Furosemide (Intravenous 40 mg and above during index admission); Admissions in past one year; Medifund (Required financial assistance); Frequent emergency department (ED) use (≥3 ED visits in 6 month before index admission); Anti-depressants in past one year; Charlson comorbidity index; End Stage Renal Failure on Dialysis; Subsidized ward stay; and Geriatric patient or not. In the experiments, the FAM-FACE-SG score had good discriminative ability with an area under the curve (AUC) of 0.839 (95% confidence interval [CI]: 0.825-0.853) for risk prediction of frequent hospital admission. In comparison, the LACE index only achieved an AUC of 0.761 (0.745-0.777).
  
  
  
  The FAM-FACE-SG score shows strong potential for implementation to provide near real-time prediction of frequent admissions. It may serve as the first step to identify high risk patients to receive resource intensive interventions.
authors.affiliation: Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore. low.lian.leng@singhealth.com.sg.|Family Medicine Program, Duke-NUS Medical School, Singapore, Singapore. low.lian.leng@singhealth.com.sg.
authors.forename: Lian Leng
authors.initials: LL
authors.lastname: Low
authors.affiliation: Health Services Research Centre, Singapore Health Services, Singapore, Singapore. liu.nan@singhealth.com.sg.|Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore. liu.nan@singhealth.com.sg.
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.affiliation: Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore.|Family Medicine Program, Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Kheng Hock
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.|Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
authors.affiliation: Integrated Health Information Systems, Singapore, Singapore.
authors.forename: Sijia
authors.initials: S
authors.lastname: Wang
authors.affiliation: Health Services Research Centre, Singapore Health Services, Singapore, Singapore.
authors.forename: Xuan
authors.initials: X
authors.lastname: Jing
authors.affiliation: Health Services Research Centre, Singapore Health Services, Singapore, Singapore.|Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000145:classification / Q000706:statistics & numerical data*; D012846:Singapore; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*
keywords: Electronic health record; Frequent hospital admitters; LACE index; Risk score; Stratification