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Review
. 2016 Sep;11(9):603-9.
doi: 10.1002/jhm.2572. Epub 2016 Feb 29.

Preparedness for hospital discharge and prediction of readmission

Amanda S Mixon  1   2   3   4 , Kathryn Goggins  5   6 , Susan P Bell  7 , Eduard E Vasilevskis  8   9   5   6   7 , Samuel Nwosu  10 , Jonathan S Schildcrout  10 , Sunil Kripalani  9   5   6   7
Affiliations
Review

Preparedness for hospital discharge and prediction of readmission

Amanda S Mixon et al. J Hosp Med. 2016 Sep.

Abstract

Background, objective: Patients' self-reported preparedness for discharge has been shown to predict readmission. It is unclear what differences exist in the predictive abilities of 2 available discharge preparedness measures. To address this gap, we conducted a comparison of these measures.

Design, setting, patients: Adults hospitalized for cardiovascular diagnoses were enrolled in a prospective cohort.

Measurements: Two patient-reported preparedness measures assessed during postdischarge calls: the 11-item Brief Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services (B-PREPARED) and the 3-item Care Transitions Measure (CTM-3). Cox proportional hazard models analyzed the relationship between preparedness and time to first readmission or death at 30 and 90 days, adjusted for readmission risk using the administrative database-derived Length of stay, Acuity, Comorbidity, and Emergency department use (LACE) index and other covariates.

Results: Median preparedness scores were: B-PREPARED 21 (interquartile range [IQR] 18-22) and CTM-3 77.8 (IQR 66.7-100). In individual Cox models, a 4-point increase in B-PREPARED score was associated with a 16% decrease in time to readmission or death at 30 and 90 days. A 10-point increase in CTM-3 score was not associated with readmission or death at 30 days, but was associated with a 6% decrease in readmission or death at 90 days. In models with both preparedness scores, B-PREPARED retained an association with readmission or death at both 30 and 90 days. However, neither preparedness score was as strong a predictor as the LACE index when all were included in the model predicting 30- and 90-day readmission or death.

Conclusion: The B-PREPARED score was more strongly associated with readmission or death than the more widely adopted CTM-3, but neither predicted readmission as well as the LACE index. Journal of Hospital Medicine 2016;11:603-609. © 2016 Society of Hospital Medicine.

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Conflict of interest statement

disclosures: Dr. Kripalani is a consultant to and holds equity in PictureRx, LLC. No other authors have conflicts of interest or financial disclosures.

Figures

Figure 1
Figure 1
Study flow diagram. ACS=acute coronary syndrome, ADHF=acute decompensated heart failure, VICS=Vanderbilt Inpatient Cohort Study
See this image and copyright information in PMC

References

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