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Predicting 30-Day Hospital Readmission Risk in a National Cohort of Patients with Cirrhosis
- Source :
- Digestive diseases and sciences, vol 65, iss 4
- Publication Year :
- 2020
- Publisher :
- eScholarship, University of California, 2020.
-
Abstract
- BackgroundEarly hospital readmission for patients with cirrhosis continues to challenge the healthcare system. Risk stratification may help tailor resources, but existing models were designed using small, single-institution cohorts or had modest performance.AimsWe leveraged a large clinical database from the Department of Veterans Affairs (VA) to design a readmission risk model for patients hospitalized with cirrhosis. Additionally, we analyzed potentially modifiable or unexplored readmission risk factors.MethodsA national VA retrospective cohort of patients with a history of cirrhosis hospitalized for any reason from January 1, 2006, to November 30, 2013, was developed from 123 centers. Using 174 candidate variables within demographics, laboratory results, vital signs, medications, diagnoses and procedures, and healthcare utilization, we built a 47-variable penalized logistic regression model with the outcome of all-cause 30-day readmission. We excluded patients who left against medical advice, transferred to a non-VA facility, or if the hospital length of stay was greater than 30days. We evaluated calibration and discrimination across variable volume and compared the performance to recalibrated preexisting risk models for readmission.ResultsWe analyzed 67,749 patients and 179,298 index hospitalizations. The 30-day readmission rate was 23%. Ascites was the most common cirrhosis-related cause of index hospitalization and readmission. The AUC of the model was 0.670 compared to existing models (0.649, 0.566, 0.577). The Brier score of 0.165 showed good calibration.ConclusionOur model achieved better discrimination and calibration compared to existing models, even after local recalibration. Assessment of calibration by variable parsimony revealed performance improvements for increasing variable inclusion well beyond those detectable for discrimination.
- Subjects :
- Liver Cirrhosis
Male
Gastroenterology & Hepatology
Prevention
Clinical Sciences
Logistic regression
Middle Aged
Hospital readmission
Patient Readmission
United States
Risk prediction
Cohort Studies
Cirrhosis
Risk Factors
Clinical Research
Calibration
Humans
Female
Patient Safety
Retrospective Studies
Forecasting
Aged
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Digestive diseases and sciences, vol 65, iss 4
- Accession number :
- edsair.od.......325..c3f01bfa289152012324bee96c21ed99