Identifying and targeting patients with predicted 30-day hospital readmissions using the revised LACE index score and early postdischarge intervention

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Abstract

Aims:

Reducing potentially avoidable hospital readmissions has been the target of several healthcare initiatives, including the readmission prevention team (RAPT) at Western Health, Melbourne. Study aims were to evaluate if the revised LACE (length of stay, acuity of admission, Charlson Comorbidity Index, emergency department visits in the past 6 months) index would identify high risk of early readmission (≤30 days postdischarge), and if postdischarge clinic and community services follow-up would reduce readmission rate.

Methods:

A prospective study was conducted among all general medicine inpatients within a tertiary hospital in Melbourne, Australia between February to April 2016, with risk screening using the revised LACE index, alongside abbreviated mental test and clinical frailty scale testing, with high-risk patients (revised LACE ≥ 8) offered specialist clinic appointment and/or referral to community services.

Results:

Among 781 patients (873 admission episodes), 358 (41.0%) admission episodes were classified as high risk of early readmission. Revised LACE index scores were equivalent for readmission vs. non-readmission episodes, {median 7 [interquartile range (IQR) 5, 8] vs. 7 [IQR 4, 8])}, as were median abbreviated mental test (8 [IQR 6, 9] vs. 8 [IQR 6, 9]) and clinical frailty scale scores (5 [IQR 3, 6] vs. 5 [IQR 3, 6]). Early readmission rates were equivalent for those who received compared with did not receive RAPT intervention (14.3 vs. 14.7%), albeit confounded by lack of identification of readmission risk using the revised LACE index. A total of 53 (14.8%) of the 358 high-risk admission episodes formally declined RAPT follow-up.

Conclusion:

This study highlighted the complexities of addressing hospital readmissions, with challenges in identifying those at risk, and low uptake and impact of current intervention strategies. Future research directions may evaluate other contributors to readmission risk, and the development of acceptable postdischarge interventions to effectively address risk.

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