BLOGS Voices Follow

1 Aug 2011

A Set of Calculators for Estimating Readmission Risk

If you are interested in a tool that estimates the readmission risk of a patient who has been hospitalized for acute myocardial infarction, heart failure, or pneumonia, you can find one at www.readmissionscore.org.

Readmission rates are increasingly a focus of quality-of-care efforts in the U.S., including those initiated by the Centers for Medicare and Medicaid Services, such as the work my colleagues and I do at the Yale-New Haven Hospital Center for Outcomes Research and Evaluation. To validate models that had been based on administrative codes, we developed models using medical records information. These models do a good job of predicting readmission risk, but they were not developed for the specific purpose of creating the tool you’ll find at readmissionscore.org.

So here are a few things to bear in mind as you use our risk calculators to help a patient make the transition from the hospital to home:

1. The calculators provide an estimate of risk, not a pinpointed assessment of it.

2. The calculators assume that the performance of the treating hospital is average in terms of readmission rates. Hospitals that perform better or worse than average may have readmission rates that differ accordingly.

3. When we developed our models, we did not seek to limit the number of variables (as the calculators do) or to include information about in-hospital adverse events. The models were intended to calculate risk using all of the information about the patient’s condition upon presentation to the hospital — that’s because they were assessing hospital quality, and we did not want to adjust for complications. Therefore, you should consider factors that may be important but are not included in the tool. I am hopeful that future calculators may improve over time.

4. The calculators do not say how to use the estimates. That’s up to you. It may be that high-risk patients (e.g., >30% chance of readmission within 30 days) would merit additional services to support the transition to home. Whether — and how — this information will improve care are questions that remain to be answered. Our hope is that we can work together with clinicians and other health care professionals who try this tool to ultimately determine how best to use it in practice.

5. We eventually want to turn these calculators into a mobile app. Because, unfortunately, the programming is expensive, we may decide to charge a modest amount to offset the costs. On the web, though, you can use the calculators for free. All the information we used to create them is in the public domain. We will be deciding about the mobile apps in the next couple of weeks. If you have an opinion, be sure to make a comment below.

Please make use of these free calculators as we all work to reduce readmission rates. And tell me: Is the tool helpful? How can it best be used to benefit patients?