Brittan MS, Martin S, Anderson L, Moss A, Torok MR. An Electronic Health Record Tool Designed to Improve Pediatric Hospital Discharge has Low Predictive Utility for Readmissions.
J Hosp Med 2018;
13:779-782. [PMID:
30156576 DOI:
10.12788/jhm.3043]
[Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We developed an electronic health record tool to improve pediatric hospital discharge. This tool flags children with three components that might complicate discharge: home health, polypharmacy (greater than or equal to 6 medications), or nonEnglish speaking caregiver. The tool tallies components and displays them as a composite score of 0-3 points. We describe the tool's development, implementation, and an evaluation of its predictive utility for 30-day unplanned readmissions in 29,542 discharged children. Of these children, 28% had a composite score of 1, 8% a score greater than or equal to 2, and 4% were readmitted. The odds of readmission was significantly higher in children with composite score of 1 versus 0 (odds ratio [OR]: 1.7; 95% CI, 1.5-2) and greater than or equal to 2 versus 0 (OR 4.2; 95% CI 3.6-4.9). The C-statistic for this model was 0.6259. Despite the positive association of the score with readmission, the tool's discriminatory performance is low. Additional research is needed to evaluate its practical benefit for improving the quality of hospital discharge. This study was supported by an institutional Clinical and Operational Effectiveness and Patient Safety Small Grants Program.
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