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Identifying Patients at Increased Risk for Unplanned Readmission

Bradley, Elizabeth H. PhD*; Yakusheva, Olga PhD; Horwitz, Leora I. MD‡,§; Sipsma, Heather PhD; Fletcher, Jason PhD*

doi: 10.1097/MLR.0b013e3182a0f492
Original Articles

Background: Reducing readmissions is a national priority, but many hospitals lack practical tools to identify patients at increased risk of unplanned readmission.

Objective: To estimate the association between a composite measure of patient condition at discharge, the Rothman Index (RI), and unplanned readmission within 30 days of discharge.

Subjects: Adult medical and surgical patients in a major teaching hospital in 2011.

Measures: The RI is a composite measure updated regularly from the electronic medical record based on changes in vital signs, nursing assessments, Braden score, cardiac rhythms, and laboratory test results. We developed 4 categories of RI and tested its association with readmission within 30 days, using logistic regression, adjusted for patient age, sex, insurance status, service assignment (medical or surgical), and primary discharge diagnosis.

Results: Sixteen percent of the sample patients (N=2730) had an unplanned readmission within 30 days of discharge. The risk of readmission for a patient in the highest risk category (RI<70) was >1 in 5 while the risk of readmission for patients in the lowest risk category was about 1 in 10. In multivariable analysis, patients with an RI<70 (the highest risk category) or 70–79 (medium risk category) had 2.65 (95% confidence interval, 1.72–4.07) and 2.40 (95% confidence interval, 1.57–3.67) times higher odds of unplanned readmission, respectively, compared with patients in the lowest risk category.

Conclusion: Clinicians can use the RI to help target hospital programs and supports to patients at highest risk of readmission.

*Department of Health Policy and Management, Yale School of Public Health, New Haven, CT

College of Business, Marquette University, Milwaukee, WI

Section of General Internal Medicine, Department of Medicine, Yale School of Medicine

§Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT

College of Nursing, University of Illinois at Chicago, Chicago, IL

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

Supported in part by the Commonwealth Fund. O.Y. was supported on the AHRQ T32 (5 T32 HS 017589) training grant. L.I.H. is supported by the National Institute on Aging (K08 AG038336), by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program, and is also a Pepper Scholar with support from the Claude D. Pepper Older Americans Independence Center at Yale University School of Medicine (#P30AG021342 NIH/NIA). L.I.H.’s salary is partially supported by Yale-New Haven Hospital. Yale-New Haven Hospital has formed a strategic and financial partnership with PeraHealth Inc., the company that developed the Rothman Index, used in this research. PeraHealth will make the Rothman Index available to researchers.

The authors declare no conflict of interest.

Reprints: Elizabeth H. Bradley, PhD, Department of Health Policy and Management, Yale School of Public Health, 60 College Street, New Haven, CT 06520. E-mail: elizabeth.bradley@yale.edu.

© 2013 by Lippincott Williams & Wilkins.