Background

The simplified HOSPITAL score is an easy-to-use prediction model to identify patients at high risk of 30-day readmission before hospital discharge. An earlier stratification of this risk would allow more preparation time for transitional care interventions.

Objective

To assess whether the simplified HOSPITAL score would perform similarly by using hemoglobin and sodium level at the time of admission instead of discharge.

Design

Prospective national multicentric cohort study.

Participants

In total, 934 consecutively discharged medical inpatients from internal general services.

Main Measures

We measured the composite of the first unplanned readmission or death within 30 days after discharge of index admission and compared the performance of the simplified score with lab at discharge (simplified HOSPITAL score) and lab at admission (early HOSPITAL score) according to their discriminatory power (Area Under the Receiver Operating characteristic Curve (AUROC)) and the Net Reclassification Improvement (NRI).

Key Results

During the study period, a total of 3239 patients were screened and 934 included. In total, 122 (13.2%) of them had a 30-day unplanned readmission or death. The simplified and the early versions of the HOSPITAL score both showed very good accuracy (Brier score 0.11, 95%CI 0.10–0.13). Their AUROC were 0.66 (95%CI 0.60–0.71), and 0.66 (95%CI 0.61–0.71), respectively, without a statistical difference ( p value 0.79). Compared with the model at discharge, the model with lab at admission showed improvement in classification based on the continuous NRI (0.28; 95%CI 0.08 to 0.48; p value 0.004).

Conclusion

The early HOSPITAL score performs, at least similarly, in identifying patients at high risk for 30-day unplanned readmission and allows a readmission risk stratification early during the hospital stay. Therefore, this new version offers a timely preparation of transition care interventions to the patients who may benefit the most.

Title	Published in	Year	Views	Downloads

The Early HOSPITAL Score to Predict 30-Day Readmission Soon After Hospitalization : a Prospective Multicenter Study	Journal of general internal medicine	2023	56	44
Gastroentérologie et hépatologie	Revue médicale suisse	2022	35	28

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Mathys, Philippe