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BMC Health Services Research

, 13:366

Healthcare needs and demand

Abstract

BackgroundHospital readmissions are serious and costly events, and readmission rates are considered to be an indicator of quality in health care management. Several models to identify patients at risk of unplanned readmissions have been developed in Western countries, but little is known about their performance in other countries. This paper reports the possible utility of one such model developed in Canada, the LACE index, in patients in a tertiary hospital in Singapore.

MethodsWe used administrative data from Singapore General Hospital for patients admitted between 1st January 2006 and 31st December 2010. Data such as demographic and clinical data including disease codes were extracted. The patient cohort was divided into two groups with a LACE index of 10 as the cutoff. Multivariate logistic regression analysis models were used to compare the outcomes between the two groups of patients with adjustment for age, sex, ethnicity, year of discharge, intensive care unit admission, and admission ward class.

ResultsOverall, 127 550 patients were eligible for analysis. Patients with a LACE index ≥ 10 had a higher risk of 30-day unplanned readmission after index discharge odds ratio OR: 4.37; 95% confidence interval CI: 4.18-4.57. After adjustment, the risk remained significant OR: 4.88; 95% CI: CI 4.57-5.22. The C-statistic for the adjusted model was 0.70 P < 0.001. Similar results were shown for 90-day unplanned readmission and emergency visits after the same adjustment.

ConclusionThe use of the LACE index may have significant application in identifying medical patients at high risk of readmission and visits to the Emergency Department in Singapore.

KeywordsUnplanned readmission LACE Emergency department Singapore Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-366 contains supplementary material, which is available to authorized users.

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Autor: Shu Yun Tan - Lian Leng Low - Yong Yang - Kheng Hock Lee

Fuente: https://link.springer.com/







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