Original Article

Readmission Risk Factors in Patients of General Surgery Wards in Shiraz Hospitals: Applying LACE Index as a Predictive Indicator

Abstract

Background: Today, the effective use of limited health care resources is increasingly regarded. Reduction of the readmission is one of the key tools can improve health outcomes and considered as one of the control levers that reduces health costs. Identifying the causes of readmission to the hospital helps to utilize hospital beds and facilities a more efficiently.
Methods: This case-control study had been conducted in general surgery (GS) wards in 2011-2012. Using chisquare test, t-test, and multiple regressions, we studied risk factors associated with readmission in both groups of case and control. Finally, the predictive power of the Length of stay, Acuity of illness, Co morbidity of the patient, Emergency (LACE) index was evaluated using receiver operating characteristic (ROC) curve.
Results: About 20% of patients in GS wards were admitted within 30 days. There is a significant difference between the two groups in the following variables: age, sex, length of hospital stay, marital status, discharge season, congestive heart failure, diabetes and renal failure. The rate of readmission with LACE index which is compared with the ROC curve shows that it is significant (P < 0.001 and Kappa = 0.22).
Conclusions: Awareness of the prevalence and risk factors of readmission is effective in planning and decision making for using hospital facilities efficiently. Identifying patients at risk of readmission and erforming training plan, ischarging and following up medical programs can reduce the rate of readmission and costs of hospital. Predicting readmission can be very effective but identifying an effective index is very difficult.

1. Amin N, Divatia JV, Agarwal V, Kulkarni AP.Readmissions in a surgical intensive care unit: patient characteristics and outcome. Indian J Crit Care Med.2003; 7(1): 14-7.
2. Tabibi S, Tourani S, Sadeghi M, Ebrahimi P. Factors involved in further reference of patients to the surgery wards of general teaching hospital. J Qazvin Univ Med Sci. 2002; 6(1): 42-8. [In Persian].
3. Stone J, Hoffman GJ. Medicare hospital readmissions:issues, policy options and PPACA [Online]. [cited 2010 Oct]; Available from: URL:
http://biblio.pennyhill.com/medicare-hospitalreadmissions-
issues-policy-options-and-ppaca/
4. Kansagara D, Englander H, Salanitro A, Kagen D,Theobald C, Freeman M, et al. Risk prediction models for hospital readmission: a systematic review. JAMA. 2011;306(15): 1688-98.
5. Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med. 2000; 160(8): 1074-81.
6. Ashton CM, Kuykendall DH, Johnson ML, Wray NP,Wu L. The association between the quality of inpatient care and early readmission. Ann Intern Med. 1995;122(6): 415-21.
7. Khoshkalan M, Zare Fazlollahi Z. The study of rehospitalization reasons in operated inpatients in Emam Hospital Urmia city 2004. J Urmia Nurs Midwifery Fac.2007; 5(1): 9-14. [In Persian].
8. Chiang JK, Fu CH, Kuo TB, Koo M. Association between frequency domain heart rate variability and unplanned readmission to hospital in geriatric patients.BMC Public Health. 2011; 11: 137.
9. Huang SH, Wang SS, Tai JJ, Lou MF. Unplanned readmission within the most recent postoperative year of heart transplant patients in Taiwan. J Clin Nurs. 2008;17(17): 2302-10.
10. Berry JG, Hall DE, Kuo DZ, Cohen E, Agrawal R,Feudtner C, et al. Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals. JAMA. 2011; 305(7): 682-90.
11. van Walraven C, Seth R, Austin PC, Laupacis A. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med. 2002;17(3): 186-92.
12. van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG,Zarnke K, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6): 551-7.
13. Krumholz HM, Brindis RG, Brush JE, Cohen DJ, Epstein AJ, Furie K, et al. Standards for statistical models used for public reporting of health outcomes: an American Heart Association Scientific Statement from the Quality of Care and Outcomes Research Interdisciplinary Writing Group: cosponsored by the Council on Epidemiology and
Prevention and the Stroke Council. Endorsed by the American College of Cardiology Foundation. Circulation.2006; 113(3): 456-62.
14. Heggestad T. Do hospital length of stay and staffing ratio affect elderly patients' risk of readmission? A nation-wide study of Norwegian hospitals. Health Serv Res. 2002;37(3): 647-65.
15. Kent TS, Sachs TE, Callery MP, Vollmer CM.Readmission after major pancreatic resection: a necessary evil? J Am Coll Surg. 2011; 213(4): 515-23.
16. Kassin MT, Owen RM, Perez SD, Leeds I, Cox JC,Schnier K, et al. Risk factors for 30-day hospital readmission among general surgery patients. J Am Coll Surg. 2012; 215(3): 322-30.
17. Goodney PP, Stukel TA, Lucas FL, Finlayson EV,Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg. 2003;238(2): 161-7.
18. Khoshkalam M. Causes of re-referring patients to hospitals Iran University of Medical Sciences [Thesis].Tehran, Iran: School of Health Management and Information Sciences, Iran University of Medical
Sciences; 1994. [In Persian].
19. Wick EC, Shore AD, Hirose K, Ibrahim AM, Gearhart SL, Efron J, et al. Readmission rates and cost following colorectal surgery. Dis Colon Rectum. 2011; 54(12):1475-9.
20. Schneider EB, Hyder O, Brooke BS, Efron J, Cameron JL, Edil BH, et al. Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. J Am Coll Surg.2012; 214(4): 390-8.
21. Kable AK, Gibberd RW, Spigelman AD. Adverse events in surgical patients in Australia. Int J Qual Health Care.2002; 14(4): 269-76.
22. Navvabi E, Derakhshan A, Sharif F, Amirghofran A,Tabatabaei H. Impacts of teaching on the anxiety level of patients have undergone coronary artery bypass graft in Nemazee Hospital in shiraz. Iran J Nurs. 2003; 16(34):25-9. [In Persian].
23. Moloney ED, Bennett K, Silke B. Patient and disease profile of emergency medical readmissions to an Irish teaching hospital. Postgrad Med J. 2004; 80(946): 470-4.
24. Jencks SF, Williams MV, Coleman EA.Rehospitalizations among patients in the medicare feefor-service program. N Engl J Med. 2009; 360: 1418-28.
25. Teixeira A, Trinquart L, Raphael M, Bastianic T,Chatellier G, Holstein J. Outcomes in older patients aftersurgical treatment for hip fracture: a new approach tocharacterise the link between readmissions and the surgical stay. Age Ageing. 2009; 38(5): 584-9.
26. Kreilkamp R. Implementation of the Modified LACE Tool [Online]. [cited 2011]; Available from: URL:http://www.slideserve.com/gaye/implementation-of-themodified-lace-tool
27. Gruneir A, Dhalla I, van Walraven C, Fischer HD,Camacho X, Rochon PA, et al. Unplanned readmissions after hospital discharge among patients identified as being at high risk for readmission using a validated predictive algorithm. Open Med. 2011; 5(2): e104-e111.
28. Cotter PE, Bhalla VK, Wallis SJ, Biram RW. Predicting readmissions: poor performance of the LACE index in anrolder UK population. Age Ageing. 2012; 41(6): 784-9.
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IssueVol 2 No 3-4 (2015) QRcode
SectionOriginal Article(s)
Published2016-01-16
Keywords
Receiver operating characteristic curve General surgery Hospitals LACE index Patients Patient readmission Risk factors

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How to Cite
1.
Hatam N, Askarian M, Khamzade F, Jafari P, Bastani P. Readmission Risk Factors in Patients of General Surgery Wards in Shiraz Hospitals: Applying LACE Index as a Predictive Indicator. AJS. 2016;2(3-4):33-38.