Preparedness for hospital discharge and prediction of readmission.

BACKGROUND, OBJECTIVE Patients' self-reported preparedness for discharge has been shown to predict readmission. It is unclear what differences exist in the predictive abilities of 2 available discharge preparedness measures. To address this gap, we conducted a comparison of these measures. DESIGN, SETTING, PATIENTS Adults hospitalized for cardiovascular diagnoses were enrolled in a prospective cohort. MEASUREMENTS Two patient-reported preparedness measures assessed during postdischarge calls: the 11-item Brief Prescriptions, Ready to re-enter community, Education, Placement, Assurance of safety, Realistic expectations, Empowerment, Directed to appropriate services (B-PREPARED) and the 3-item Care Transitions Measure (CTM-3). Cox proportional hazard models analyzed the relationship between preparedness and time to first readmission or death at 30 and 90 days, adjusted for readmission risk using the administrative database-derived Length of stay, Acuity, Comorbidity, and Emergency department use (LACE) index and other covariates. RESULTS Median preparedness scores were: B-PREPARED 21 (interquartile range [IQR] 18-22) and CTM-3 77.8 (IQR 66.7-100). In individual Cox models, a 4-point increase in B-PREPARED score was associated with a 16% decrease in time to readmission or death at 30 and 90 days. A 10-point increase in CTM-3 score was not associated with readmission or death at 30 days, but was associated with a 6% decrease in readmission or death at 90 days. In models with both preparedness scores, B-PREPARED retained an association with readmission or death at both 30 and 90 days. However, neither preparedness score was as strong a predictor as the LACE index when all were included in the model predicting 30- and 90-day readmission or death. CONCLUSION The B-PREPARED score was more strongly associated with readmission or death than the more widely adopted CTM-3, but neither predicted readmission as well as the LACE index. Journal of Hospital Medicine 2016;11:603-609. © 2016 Society of Hospital Medicine.

[1]  F. McAlister,et al.  Patient-Reported Discharge Readiness and 30-Day Risk of Readmission or Death: A Prospective Cohort Study. , 2016, The American journal of medicine.

[2]  E. Coleman,et al.  Assessing the Quality of Preparation for Posthospital Care from the Patient's Perspective: The Care Transitions Measure , 2005, Medical care.

[3]  Rebecca L. Kinney,et al.  Psychometric Evaluation of the Care Transition Measure in TRACE‐CORE: Do We Need a Better Measure? , 2014, Journal of the American Heart Association.

[4]  S. Kripalani,et al.  Assessing preventability in the quest to reduce hospital readmissions. , 2014, Journal of hospital medicine.

[5]  LeeAnna Spiva,et al.  Validation of a Predictive Model to Identify Patients at High Risk for Hospital Readmission , 2016, Journal for healthcare quality : official publication of the National Association for Healthcare Quality.

[6]  Amanda H. Salanitro,et al.  Determinants of health after hospital discharge: rationale and design of the Vanderbilt Inpatient Cohort Study (VICS) , 2014, BMC Health Services Research.

[7]  J. Aldag,et al.  Brief scale measuring patient preparedness for hospital discharge to home: Psychometric properties. , 2008, Journal of hospital medicine.

[8]  E. Coleman,et al.  The Central Role of Performance Measurement in Improving the Quality of Transitional Care , 2007, Home health care services quarterly.

[9]  E. Coleman,et al.  Implementation of the Care Transitions Intervention: Sustainability and Lessons Learned , 2009, Professional case management.

[10]  Hao Wang,et al.  Using the LACE index to predict hospital readmissions in congestive heart failure patients , 2014, BMC Cardiovascular Disorders.

[11]  E. Coleman,et al.  Assessing the Quality of Transitional Care: Further Applications of the Care Transitions Measure , 2008, Medical care.

[12]  Amanda H. Salanitro,et al.  Risk prediction models for hospital readmission: a systematic review. , 2011, JAMA.

[13]  D. Kansagara,et al.  The Care Transitions Innovation (C-TraIn) for Socioeconomically Disadvantaged Adults: Results of a Cluster Randomized Controlled Trial , 2014, Journal of General Internal Medicine.

[14]  C. Rand,et al.  Telephone calls to patients after discharge from the hospital: an important part of transitions of care , 2015, Medical education online.

[15]  P. Austin,et al.  Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community , 2010, Canadian Medical Association Journal.