Dataset Information

An automated model using electronic medical record data identifies patients with cirrhosis at high risk for readmission.

ABSTRACT:

Background & aims

Patients with cirrhosis have 1-month rates of readmission as high as 35%. Early identification of high-risk patients could permit interventions to reduce readmission. The aim of our study was to construct an automated 30-day readmission risk model for cirrhotic patients using electronic medical record (EMR) data available early during hospitalization.

Methods

We identified patients with cirrhosis admitted to a large safety-net hospital from January 2008 through December 2009. A multiple logistic regression model for 30-day rehospitalization was developed using medical and socioeconomic factors available within 48 hours of admission and tested on a validation cohort. Discrimination was assessed using receiver operator characteristic curve analysis.

Results

We identified 836 cirrhotic patients with 1291 unique admission encounters. Rehospitalization occurred within 30 days for 27% of patients. Significant predictors of 30-day readmission included the number of address changes in the prior year (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.05-1.21), number of admissions in the prior year (OR, 1.14; 95% CI, 1.05-1.24), Medicaid insurance (OR, 1.53; 95% CI, 1.10-2.13), thrombocytopenia (OR, 0.50; 95% CI, 0.35-0.72), low level of alanine aminotransferase (OR, 2.56; 95% CI, 1.09-6.00), anemia (OR, 1.63; 95% CI, 1.17-2.27), hyponatremia (OR, 1.78; 95% CI, 1.14-2.80), and Model for End-stage Liver Disease score (OR, 1.04; 95% CI, 1.01-1.06). The risk model predicted 30-day readmission, with c-statistics of 0.68 (95% CI, 0.64-0.72) and 0.66 (95% CI, 0.59-0.73) in the derivation and validation cohorts, respectively.

Conclusions

Clinical and social factors available early during admission and extractable from an EMR predicted 30-day readmission in cirrhotic patients with moderate accuracy. Decision support tools that use EMR-automated data are useful for risk stratification of patients with cirrhosis early during hospitalization.

SUBMITTER: Singal AG

PROVIDER: S-EPMC3851321 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

An automated model using electronic medical record data identifies patients with cirrhosis at high risk for readmission.

Singal Amit G AG Rahimi Robert S RS Clark Christopher C Ma Ying Y Cuthbert Jennifer A JA Rockey Don C DC Amarasingham Ruben R

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20130413 10

<h4>Background & aims</h4>Patients with cirrhosis have 1-month rates of readmission as high as 35%. Early identification of high-risk patients could permit interventions to reduce readmission. The aim of our study was to construct an automated 30-day readmission risk model for cirrhotic patients using electronic medical record (EMR) data available early during hospitalization.<h4>Methods</h4>We identified patients with cirrhosis admitted to a large safety-net hospital from January 2008 through D ...[more]

PMID: 23591286

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Dataset Information

An automated model using electronic medical record data identifies patients with cirrhosis at high risk for readmission.

Background & aims

Methods

Results

Conclusions

Publications

An automated model using electronic medical record data identifies patients with cirrhosis at high risk for readmission.

Similar Datasets

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