551R eadmission to hospital and death are adverse patient outcomes that are serious, common and costly.1,2 Several studies suggest that focused care after discharge can improve post-discharge outcomes.3-7 Being able to accurately predict the risk of poor outcomes after hospital discharge would allow health care workers to focus post-discharge interventions on patients who are at highest risk of poor post-discharge outcomes. Further, policy-makers have expressed interest in either penalizing hospitals with relatively high rates of readmission or rewarding hospitals with relatively low expected rates. 8 To implement this approach, a validated method of standardizing readmission rates is needed.
9Two validated models for predicting risk of readmission after hospital discharge have been published. 10,11 However, these models are impractical to clinicians. Both require arealevel information (e.g., neighbourhood socio-economic status and community-specific rates of admission) that is not readily available. Getting this information requires access to detailed tables, thereby making the model impractical. Second, both models are so complex that risk estimates cannot be attained from them without the aid of special software. Although these models have been used by health-system planners in the United Kingdom, we are unaware of any clinicians who use them when preparing patients for hospital discharge.Our primary objective was to derive and validate a clinically useful index to quantify the risk of early death or unplanned readmission among patients discharged from hospital to the community.
Methods
Study designWe performed a secondary analysis of a multicentre prospective cohort study conducted between
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