Risk Factors for Emergency Department Short Time Readmission in Stratified Population

Overview

Journal Biomed Res Int

Publisher Wiley

Specialties Biomedical Engineering
Biotechnology
General Medicine

Date 2015 Dec 19

PMID 26682222

Citations 4

Authors

Ariadna Besga

Borja Ayerdi

Guillermo Alcalde

Alberto Manzano

Pedro Lopetegui

Manuel Grana

Ana Gonzalez-Pinto

Affiliations

Soon will be listed here.

Abstract

Background: Emergency department (ED) readmissions are considered an indicator of healthcare quality that is particularly relevant in older adults. The primary objective of this study was to identify key factors for predicting patients returning to the ED within 30 days of being discharged.

Methods: We analysed patients who attended our ED in June 2014, stratified into four groups based on the Kaiser pyramid. We collected data on more than 100 variables per case including demographic and clinical characteristics and drug treatments. We identified the variables with the highest discriminating power to predict ED readmission and constructed classifiers using machine learning methods to provide predictions.

Results: Classifier performance distinguishing between patients who were and were not readmitted (within 30 days), in terms of average accuracy (AC). The variables with the greatest discriminating power were age, comorbidity, reasons for consultation, social factors, and drug treatments.

Conclusions: It is possible to predict readmissions in stratified groups with high accuracy and to identify the most important factors influencing the event. Therefore, it will be possible to develop interventions to improve the quality of care provided to ED patients.

Citing Articles

Reducing 48-h emergency department revisits and subsequent admissions: a retrospective study of increased emergency medicine resident floor coverage.

Palungwachira P, Montimanutt G, Musikatavorn K, Savatmongkorngul S Int J Emerg Med. 2022; 15(1):66.

PMID: 36474146 PMC: 9724369. DOI: 10.1186/s12245-022-00471-z.

Survival of Frail Elderly with Delirium.

Cano-Escalera G, Grana M, Irazusta J, Labayen I, Besga A Int J Environ Res Public Health. 2022; 19(4).

PMID: 35206439 PMC: 8872606. DOI: 10.3390/ijerph19042247.

Using explainable machine learning to identify patients at risk of reattendance at discharge from emergency departments.

Chmiel F, Burns D, Azor M, Borca F, Boniface M, Zlatev Z Sci Rep. 2021; 11(1):21513.

PMID: 34728706 PMC: 8563762. DOI: 10.1038/s41598-021-00937-9.

Machine Learning Readmission Risk Modeling: A Pediatric Case Study.

Wolff P, Grana M, Rios S, Yarza M Biomed Res Int. 2019; 2019:8532892.

PMID: 31139655 PMC: 6500604. DOI: 10.1155/2019/8532892.

References

Ozcimen M, Sakarya Y, Kurtipek E, Bekci T, Goktas S, Sakarya R . Peripapillary choroidal thickness in patients with chronic obstructive pulmonary disease. Cutan Ocul Toxicol. 2015; 35(1):26-30. DOI: 10.3109/15569527.2015.1004079. View

Welch B . The generalisation of student's problems when several different population variances are involved. Biometrika. 2010; 34(1-2):28-35. DOI: 10.1093/biomet/34.1-2.28. View

Hustey F, Meldon S . The prevalence and documentation of impaired mental status in elderly emergency department patients. Ann Emerg Med. 2002; 39(3):248-53. DOI: 10.1067/mem.2002.122057. View

Hogan T, Olade T, Carpenter C . A profile of acute care in an aging America: snowball sample identification and characterization of United States geriatric emergency departments in 2013. Acad Emerg Med. 2014; 21(3):337-46. DOI: 10.1111/acem.12332. View

Meldon S, Mion L, Palmer R, Drew B, Connor J, Lewicki L . A brief risk-stratification tool to predict repeat emergency department visits and hospitalizations in older patients discharged from the emergency department. Acad Emerg Med. 2003; 10(3):224-32. DOI: 10.1111/j.1553-2712.2003.tb01996.x. View

Jencks S, Williams M, Coleman E . Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-28. DOI: 10.1056/NEJMsa0803563. View

Pereira L, Choquet C, Perozziello A, Wargon M, Juillien G, Colosi L . Unscheduled-return-visits after an emergency department (ED) attendance and clinical link between both visits in patients aged 75 years and over: a prospective observational study. PLoS One. 2015; 10(4):e0123803. PMC: 4390330. DOI: 10.1371/journal.pone.0123803. View

Carpenter C, Heard K, Wilber S, Ginde A, Stiffler K, Gerson L . Research priorities for high-quality geriatric emergency care: medication management, screening, and prevention and functional assessment. Acad Emerg Med. 2011; 18(6):644-54. PMC: 3117251. DOI: 10.1111/j.1553-2712.2011.01092.x. View

Martin-Sanchez F, Gonzalez Armengol J . [Emergency Departments: one more link in the chain in chronic diseases strategies]. Aten Primaria. 2014; 46(5):267-8. PMC: 6983610. DOI: 10.1016/j.aprim.2013.10.007. View

10.

Iwasaki S, Yamasoba T . Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Dis. 2015; 6(1):38-47. PMC: 4306472. DOI: 10.14336/AD.2014.0128. View

11.

Carpenter C, Bromley M, Caterino J, Chun A, Gerson L, Greenspan J . Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic.... J Am Geriatr Soc. 2014; 62(7):1360-3. DOI: 10.1111/jgs.12883. View

12.

Morris J, Howard E, Steel K, Schreiber R, Fries B, Lipsitz L . Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data. BMC Health Serv Res. 2014; 14:519. PMC: 4236798. DOI: 10.1186/s12913-014-0519-z. View

13.

Silveira E, Montero Errasquin B, Garcia M, Velez-Diaz-Pallares M, Lozano Montoya I, Sanchez-Castellano C . [Improving drug prescribing in the elderly: a new edition of STOPP/START criteria]. Rev Esp Geriatr Gerontol. 2014; 50(2):89-96. DOI: 10.1016/j.regg.2014.10.005. View

14.

Wilber S, Lofgren S, Mager T, Blanda M, Gerson L . An evaluation of two screening tools for cognitive impairment in older emergency department patients. Acad Emerg Med. 2005; 12(7):612-6. DOI: 10.1197/j.aem.2005.01.017. View

15.

Lopez-Aguila S, Contel J, Farre J, Campuzano J, Rajmil L . Predictive model for emergency hospital admission and 6-month readmission. Am J Manag Care. 2011; 17(9):e348-57. View

16.

Silverstein M, Qin H, Mercer S, Fong J, Haydar Z . Risk factors for 30-day hospital readmission in patients ≥65 years of age. Proc (Bayl Univ Med Cent). 2008; 21(4):363-72. PMC: 2566906. DOI: 10.1080/08998280.2008.11928429. View

17.

Yam C, Wong E, Chan F, Wong F, Leung M, Yeoh E . Measuring and preventing potentially avoidable hospital readmissions: a review of the literature. Hong Kong Med J. 2010; 16(5):383-9. View

18.

Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M . Risk prediction models for hospital readmission: a systematic review. JAMA. 2011; 306(15):1688-98. PMC: 3603349. DOI: 10.1001/jama.2011.1515. View

19.

. New guidelines for geriatric EDs: guidance focused on boosting environment, care processes. ED Manag. 2014; 26(5):49-53. View

20.

Garrison G, Mansukhani M, Bohn B . Predictors of thirty-day readmission among hospitalized family medicine patients. J Am Board Fam Med. 2013; 26(1):71-7. DOI: 10.3122/jabfm.2013.01.120107. View