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External validation of the PAR-Risk Score to assess potentially avoidable hospital readmission risk in internal medicine patients

Author

Listed:
  • Lukas Higi
  • Angela Lisibach
  • Patrick E Beeler
  • Monika Lutters
  • Anne-Laure Blanc
  • Andrea M Burden
  • Dominik Stämpfli

Abstract

Background: Readmission prediction models have been developed and validated for targeted in-hospital preventive interventions. We aimed to externally validate the Potentially Avoidable Readmission-Risk Score (PAR-Risk Score), a 12-items prediction model for internal medicine patients with a convenient scoring system, for our local patient cohort. Methods: A cohort study using electronic health record data from the internal medicine ward of a Swiss tertiary teaching hospital was conducted. The individual PAR-Risk Score values were calculated for each patient. Univariable logistic regression was used to predict potentially avoidable readmissions (PARs), as identified by the SQLape algorithm. For additional analyses, patients were stratified into low, medium, and high risk according to tertiles based on the PAR-Risk Score. Statistical associations between predictor variables and PAR as outcome were assessed using both univariable and multivariable logistic regression. Results: The final dataset consisted of 5,985 patients. Of these, 340 patients (5.7%) experienced a PAR. The overall PAR-Risk Score showed rather poor discriminatory power (C statistic 0.605, 95%-CI 0.575–0.635). When using stratified groups (low, medium, high), patients in the high-risk group were at statistically significant higher odds (OR 2.63, 95%-CI 1.33–5.18) of being readmitted within 30 days compared to low risk patients. Multivariable logistic regression identified previous admission within six months, anaemia, heart failure, and opioids to be significantly associated with PAR in this patient cohort. Conclusion: This external validation showed a limited overall performance of the PAR-Risk Score, although higher scores were associated with an increased risk for PAR and patients in the high-risk group were at significantly higher odds of being readmitted within 30 days. This study highlights the importance of externally validating prediction models.

Suggested Citation

  • Lukas Higi & Angela Lisibach & Patrick E Beeler & Monika Lutters & Anne-Laure Blanc & Andrea M Burden & Dominik Stämpfli, 2021. "External validation of the PAR-Risk Score to assess potentially avoidable hospital readmission risk in internal medicine patients," PLOS ONE, Public Library of Science, vol. 16(11), pages 1-14, November.
    • Handle: RePEc:plo:pone00:0259864
    DOI: 10.1371/journal.pone.0259864
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    1. Anne-Laure Blanc & Thierry Fumeaux & Jérôme Stirnemann & Elise Dupuis Lozeron & Aimad Ourhamoune & Jules Desmeules & Pierre Chopard & Arnaud Perrier & Nicolas Schaad & Pascal Bonnabry, 2019. "Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-16, July.
    2. Grolemund, Garrett & Wickham, Hadley, 2011. "Dates and Times Made Easy with lubridate," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 40(i03).
    3. Karel G M Moons & Joris A H de Groot & Walter Bouwmeester & Yvonne Vergouwe & Susan Mallett & Douglas G Altman & Johannes B Reitsma & Gary S Collins, 2014. "Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies: The CHARMS Checklist," PLOS Medicine, Public Library of Science, vol. 11(10), pages 1-12, October.
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