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Smith LN, Makam AN, Darden D, Mayo H, Das SR, Halm EA, Nguyen OK. Acute Myocardial Infarction Readmission Risk Prediction Models: A Systematic Review of Model Performance. Circ Cardiovasc Qual Outcomes 2019; 11:e003885. [PMID: 29321135 DOI: 10.1161/circoutcomes.117.003885] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 12/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospitals are subject to federal financial penalties for excessive 30-day hospital readmissions for acute myocardial infarction (AMI). Prospectively identifying patients hospitalized with AMI at high risk for readmission could help prevent 30-day readmissions by enabling targeted interventions. However, the performance of AMI-specific readmission risk prediction models is unknown. METHODS AND RESULTS We systematically searched the published literature through March 2017 for studies of risk prediction models for 30-day hospital readmission among adults with AMI. We identified 11 studies of 18 unique risk prediction models across diverse settings primarily in the United States, of which 16 models were specific to AMI. The median overall observed all-cause 30-day readmission rate across studies was 16.3% (range, 10.6%-21.0%). Six models were based on administrative data; 4 on electronic health record data; 3 on clinical hospital data; and 5 on cardiac registry data. Models included 7 to 37 predictors, of which demographics, comorbidities, and utilization metrics were the most frequently included domains. Most models, including the Centers for Medicare and Medicaid Services AMI administrative model, had modest discrimination (median C statistic, 0.65; range, 0.53-0.79). Of the 16 reported AMI-specific models, only 8 models were assessed in a validation cohort, limiting generalizability. Observed risk-stratified readmission rates ranged from 3.0% among the lowest-risk individuals to 43.0% among the highest-risk individuals, suggesting good risk stratification across all models. CONCLUSIONS Current AMI-specific readmission risk prediction models have modest predictive ability and uncertain generalizability given methodological limitations. No existing models provide actionable information in real time to enable early identification and risk-stratification of patients with AMI before hospital discharge, a functionality needed to optimize the potential effectiveness of readmission reduction interventions.
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Affiliation(s)
- Lauren N Smith
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Anil N Makam
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Douglas Darden
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Helen Mayo
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Sandeep R Das
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Ethan A Halm
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.)
| | - Oanh Kieu Nguyen
- From the Department of Internal Medicine (L.N.S., A.N.M., S.R.D., E.A.H., O.K.N.), Department of Clinical Sciences (A.N.M., E.A.H., O.K.N.), and Health Sciences Digital Library and Learning Center (H.M.), UT Southwestern Medical Center, Dallas, TX; and Department of Internal Medicine, University of California San Diego, La Jolla (D.D.).
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11
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Lage DE, Nipp RD, D'Arpino SM, Moran SM, Johnson PC, Wong RL, Pirl WF, Hochberg EP, Traeger LN, Jackson VA, Cashavelly BJ, Martinson HS, Greer JA, Ryan DP, Temel JS, El-Jawahri A. Predictors of Posthospital Transitions of Care in Patients With Advanced Cancer. J Clin Oncol 2017; 36:76-82. [PMID: 29068784 DOI: 10.1200/jco.2017.74.0340] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Patients with advanced cancer experience potentially burdensome transitions of care after hospitalizations. We examined predictors of discharge location and assessed the relationship between discharge location and survival in this population. Methods We conducted a prospective study of 932 patients with advanced cancer who experienced an unplanned hospitalization between September 2014 and March 2016. Upon admission, we assessed patients' physical symptoms (Edmonton Symptom Assessment System) and psychological distress (Patient Health Questionnaire-4). The primary outcome was discharge location (home without hospice, postacute care [PAC], or hospice [any setting]). The secondary outcome was survival. Results Of 932 patients, 726 (77.9%) were discharged home without hospice, 118 (12.7%) were discharged to PAC, and 88 (9.4%) to hospice. Those discharged to PAC and hospice reported high rates of severe symptoms, including dyspnea, constipation, low appetite, fatigue, depression, and anxiety. Using logistic regression, patients discharged to PAC or hospice versus home without hospice were more likely to be older (odds ratio [OR], 1.03; 95% CI, 1.02 to 1.05; P < .001), live alone (OR, 1.95; 95% CI, 1.25 to 3.02; P < .003), have impaired mobility (OR, 5.08; 95% CI, 3.46 to 7.45; P < .001), longer hospital stays (OR, 1.15; 95% CI, 1.11 to 1.20; P < .001), higher Edmonton Symptom Assessment System physical symptoms (OR, 1.02; 95% CI, 1.003 to 1.032; P < .017), and higher Patient Health Questionnaire-4 depression symptoms (OR, 1.13; 95% CI, 1.01 to 1.25; P < .027). Patients discharged to hospice rather than PAC were more likely to receive palliative care consultation (OR, 4.44; 95% CI, 2.12 to 9.29; P < .001) and have shorter hospital stays (OR, 0.84; 95% CI, 0.77 to 0.91; P < .001). Patients discharged to PAC versus home had lower survival (hazard ratio, 1.53; 95% CI, 1.22 to 1.93; P < .001). Conclusion Patients with advanced cancer who were discharged to PAC facilities and hospice had substantial physical and psychological symptom burden, impaired physical function, and inferior survival compared with those discharged to home. These patients may benefit from interventions to enhance their quality of life and care.
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Affiliation(s)
- Daniel E Lage
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Ryan D Nipp
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Sara M D'Arpino
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Samantha M Moran
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - P Connor Johnson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Risa L Wong
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - William F Pirl
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Ephraim P Hochberg
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Lara N Traeger
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Vicki A Jackson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Barbara J Cashavelly
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Holly S Martinson
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Joseph A Greer
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - David P Ryan
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Jennifer S Temel
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
| | - Areej El-Jawahri
- Daniel E. Lage, Ryan D. Nipp, Sara M. D'Arpino, Samantha M. Moran, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Barbara J. Cashavelly, Holly S. Martinson, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Massachusetts General Hospital Cancer Center; Daniel E. Lage, Ryan D. Nipp, P. Connor Johnson, Risa L. Wong, Ephraim P. Hochberg, Lara N. Traeger, Vicki A. Jackson, Joseph A. Greer, David P. Ryan, Jennifer S. Temel, and Areej El-Jawahri, Harvard Medical School; Lara N. Traeger, Vicki A. Jackson, and Joseph A. Greer, Massachusetts General Hospital, Boston, MA; and William F. Pirl, Sylvester Comprehensive Cancer Center and University of Miami, Miami, FL
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