Development and validation of a simple risk score to predict 30‐day readmission after percutaneous coronary intervention in a cohort of medicare patients. Issue 6 (12th August 2016)

• Record Type: Journal Article
• Authors: Minges, Karl E.; Herrin, Jeph; Fiorilli, Paul N.; Curtis, Jeptha P.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 89:Issue 6(2017)
• Page Start: 955
• Page End: 963
• Publication Date: 2016-08-12
• Subjects: percutaneous coronary intervention -- health care outcomes -- risk stratification -- Medicare -- quality improvement; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.26701
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract : Objectives: To develop a risk model that can be used to identify PCI patients at higher risk of readmission who may benefit from additional resources at the time of discharge. Background: A high proportion of patients undergoing PCI are readmitted within 30 days of discharge. Methods: The sample comprised patients aged ≥65 years who underwent PCI at a CathPCI Registry®‐participating hospital and could be linked with 100% Medicare fee‐for‐service claims between 01/2007 and 12/2009. The sample ( n = 388, 078) was randomly divided into risk score development ( n = 193, 899) and validation ( n = 194, 179) cohorts. We did not count as readmissions those associated with staged revascularization procedures. Multivariable logistic regression models using stepwise selection models were estimated to identify variables independently associated with all‐cause 30‐day readmission. Results: The mean 30‐day readmission rates for the development (11.36%) and validation (11.35%) cohorts were similar. In total, 19 variables were significantly associated with risk of 30‐day readmission ( P < 0.05), and model c‐statistics were similar in the development (0.67) and validation (0.66) cohorts. The simple risk score based on 14 variables identified patients at high and low risk of readmission. Patients with a score of ≥13 (15.4% of sample) had more than an 18.5% risk of readmission, while patients with a score ≤6 (41.9% of sample) had less than an 8% risk of readmission. Conclusion: Among PCI patients, risk of readmission can be estimated using clinical factors present at the time of the procedure. This risk score may guide clinical decision‐making and resource allocation for PCI patients at the time of hospital discharge. © 2016 Wiley Periodicals, Inc.