Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score
Abstract
:1. Introduction
2. Materials and Methods
Cut-Off and Interpretation | |
---|---|
Mini-Mental State Examination (MMSE) | 22-item questionnaire on time and place orientation, registration, attention and calculation, recall, language, repetition, and constructional ability, with total score of 30. Patients are considered with cognitive impairment if ≤24 in the literate and ≤13 in the illiterate [23,25]. |
Mini-Cog | Two-part exam on memory and orientation—three-item recall and clock drawing test (CDT) [36,37]. Patients are considered demented if there are 0 items recalled or clock drawing test is abnormal with 1–2 items being recalled. |
5-item Geriatric Depression Scale (GDS-5) | 5-item questionnaire on depressive symptoms with total score of 0–5 [26,38,39]. Patients are considered with depressive symptoms if points ≤2 and psychiatric consultation is suggested. |
Barthel Index (BI) for Activities of Daily Living (ADL) | 10-item questionnaire on one’s ability of feeding, bathing, grooming, dressing, bowel control, bladder control, toilet use, transferring, and mobility on level surfaces and stairs [32]; total score of 0–100, from total dependence to complete independence. |
Lawton–Brody scale for Instrumental Activities of Daily Living (IADL) | 8-item questionnaire on one’s ability of using a telephone, laundry, shopping, preparing food, housekeeping, using transportation, managing one’s own medication, and handling finance [33,40]; total score 0–8, from lower physical and cognitive function to higher function. |
Mini-Nutritional Assessment (MNA) | 30-point questionnaire on dietary and nutritional status, with total score 0–30. Patients are considered with adequate nutritional status if scored ≥24 and malnutrition if scored <17; there is higher risk of malnutrition if scored between 17 and 23.5 [27,41]. |
6 m Walking Speed (6M) | Gait speed less than 1 m/s indicated low physical performance [42]. |
Timed Up and Go test (TUG) | Time measured from standing up from a chair, walking for 3 m, returning to the chair, and sitting. Frailty and gait impairment is considered if the patient took more than 30 s to complete the test, and gait aid is required [31]. |
3. Results
3.1. Baseline Characteristics, CGA, and 30-Day Readmission
3.2. LACE Index and HOSPITAL Score and 30-Day Readmission
3.3. LACE Index and HOSPITAL Score in Subgroup Patients with Physical Limitation and Malnutrition and 30-Day Readmission
4. Discussion
4.1. CGA and Readmission
4.2. LACE/HOSPITAL and Readmission
4.3. Strength and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics | Total (n = 1509) | Non-Readmitted (n = 1276) | Readmitted (n = 233) | p Value |
---|---|---|---|---|
Sociodemographic | ||||
Age (years) | 82 (75–87) | 82 (75–87) | 82 (74.5–87) | 0.768 |
Sex, n (%) | 0.040 * | |||
Male | 929 (61.56%) | 771 (60.4%) | 158 (67.8%) | |
Female | 580 (38.44%) | 505 (39.6%) | 75 (32.2%) | |
Living situation, n (%) | 0.846 | |||
Alone | 137 (9.08%) | 117 (9.2%) | 20 (8.6%) | |
With relatives | 1230 (81.51%) | 1037 (81.3%) | 193 (82.8%) | |
Others | 142 (9.41%) | 122 (9.6%) | 20 (8.6%) | |
Educational level | 0.362 | |||
Illiterate | 398 (26.38%) | 346 (27.1%) | 52 (22.3%) | |
Literate or primary school | 576 (38.17%) | 477 (37.4%) | 99 (42.5%) | |
Junior to senior high school | 376 (24.92%) | 317 (24.8%) | 59 (25.3%) | |
University | 159 (10.54%) | 136 (10.7%) | 23 (9.9%) | |
Marital status, n(%) | 0.281 | |||
Single | 46 (3.05%) | 42 (3.3%) | 4 (1.7%) | |
Married | 1463 (96.95%) | 1234 (96.7%) | 229 (98.3%) | |
Age-adjusted Charlson Comorbidity Index (ACCI) | 2 (1–3) | 2 (1–3) | 3 (2–4) | 0.005 ** |
CGA upon admission | ||||
ADL | 50 (15–75) | 50 (15–75) | 40 (10–67.5) | 0.005 ** |
IADL | 1 (0–4) | 2 (0–4) | 1 (0–3) | 0.008 ** |
MMSE | 21 (15–26) | 21 (15–26) | 20 (16–26) | 0.895 |
MNA | 21 (16.5–24) | 21 (16.5–24.5) | 19.5 (16–23.5) | 0.005 ** |
TUG | 19.2 (13.6–27.28) | 18.8 (13.3–26.83) | 20.24 (15.37–29.95) | 0.070 |
Mini-cog | 1 (0–1) | 1 (0–1) | 1 (0–1) | 0.279 |
GDS | 1 (0–2) | 1 (0–2) | 1 (0–3) | 0.144 |
6M | 13 (9–20) | 12.7 (9–20) | 14.3 (8.88–20.19) | 0.440 |
Gait ability | 0.001 ** | |||
0–1 | 1029 (68.19%) | 894 (70.1%) | 135 (57.9%) | |
2–3 | 269 (17.83%) | 213 (16.7%) | 56 (24.0%) | |
4 | 211 (13.98%) | 169 (13.2%) | 42 (18.0%) | |
Hospital score | 4 (4–5) | 4 (4–5) | 5 (4–5) | <0.001 ** |
Hospital score > 5 | 213 (14.12%) | 157 (12.3%) | 56 (24.0%) | <0.001 ** |
LACE index | 11 (9–13) | 11 (9–13) | 12 (10–14) | <0.001 ** |
LACE index > 15 | 137 (9.08%) | 97 (7.6%) | 40 (17.2%) | <0.001 ** |
Length of stay | 10 (7–16) | 10 (7–15) | 11 (8–17) | 0.005 ** |
Length of stay ≥ 14 | 517 (34.26%) | 424 (33.2%) | 93 (39.9%) | 0.057 |
N of hospitalization in 6 months prior to index admission | <0.001 ** | |||
No | 1157 (76.67%) | 998 (78.2%) | 159 (68.2%) | |
1 | 238 (15.77%) | 201 (15.8%) | 37 (15.9%) | |
2 | 70 (4.64%) | 53 (4.2%) | 17 (7.3%) | |
≥3 | 44 (2.92%) | 24 (1.9%) | 20 (8.6%) | |
N of ER visits in 6 months prior to index admission | <0.001 ** | |||
No | 385 (25.51%) | 336 (26.3%) | 49 (21.0%) | |
1 | 695 (46.06%) | 604 (47.3%) | 91 (39.1%) | |
2 | 231 (15.31%) | 194 (15.2%) | 37 (15.9%) | |
3 | 99 (6.56%) | 80 (6.3%) | 19 (8.2%) | |
≥4 | 99 (6.56%) | 62 (4.9%) | 37 (15.9%) | |
Laboratory data | ||||
Serum Creatinine | 1.02 (0.78–1.5) | 1 (0.76–1.48) | 1.11 (0.8–1.69) | 0.023 * |
Serum hemoglobin | 11.2 (9.7–12.7) | 11.2 (9.7–12.7) | 10.9 (9.55–12.65) | 0.189 |
Serum Sodium | 139 (136–141) | 139 (136–142) | 138 (135–141) | 0.045 * |
Univariate | Multivariate (HOSPITAL Score) | Multivariate (LACE Index) | |||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95%CI | p Value | OR | 95%CI | p Value | OR | 95%CI | p Value | |
Age | 1.00 | (0.98–1.02) | 0.838 | 0.98 | (0.97–1.00) | 0.101 | 0.98 | (0.97–1.00) | 0.123 |
Sex | |||||||||
Male | ref | ref | ref | ||||||
Female | 0.72 | (0.54–0.98) | 0.034 * | 0.67 | (0.49–0.92) | 0.012 * | 0.70 | (0.51–0.95) | 0.023 * |
Hospital score | 1.36 | (1.21–1.53) | <0.001 ** | 1.33 | (1.17–1.50) | <0.001 ** | |||
LACE index | 1.12 | (1.07–1.18) | <0.001 ** | 1.10 | (1.05–1.16) | <0.001 ** | |||
Gait ability | |||||||||
0–1 | ref | ref | ref | ||||||
2–3 | 1.74 | (1.23–2.46) | 0.002 ** | 1.51 | (1.01–2.25) | 0.043 * | 1.47 | (0.99–2.19) | 0.057 |
4 | 1.65 | (1.12–2.41) | 0.011 * | 1.25 | (0.77–2.05) | 0.370 | 1.23 | (0.75–2.01) | 0.410 |
Assessment upon admission | |||||||||
ADL | 0.99 | (0.99–1.00) | 0.005 ** | 1.00 | (0.99–1.01) | 0.628 | 1.00 | (0.99–1.01) | 0.715 |
MNA | 0.96 | (0.94–0.99) | 0.006 ** | 1.00 | (0.96–1.04) | 0.828 | 0.99 | (0.96–1.03) | 0.772 |
Sensitivity | Specificity | |
---|---|---|
LACE index | ||
3 | 0.0% | 99.6% |
4 | 0.4% | 99.2% |
5 | 1.3% | 97.6% |
6 | 2.1% | 96.0% |
7 | 3.4% | 94.4% |
8 | 5.2% | 92.8% |
9 | 6.9% | 89.6% |
10 | 15.9% | 86.8% |
11 | 9.0% | 87.2% |
12 | 12.9% | 88.0% |
13 | 10.3% | 90.0% |
14 | 8.6% | 90.0% |
15 | 6.9% | 96.3% |
16 | 8.6% | 95.8% |
17 | 5.2% | 97.9% |
18 | 0.9% | 99.5% |
19 | 2.6% | 99.2% |
Hospital score | ||
1 | 0.9% | 98.0% |
2 | 1.7% | 95.5% |
3 | 10.7% | 86.8% |
4 | 26.6% | 66.2% |
5 | 36.1% | 65.8% |
6 | 15.0% | 91.2% |
7 | 6.0% | 97.4% |
8 | 1.7% | 99.1% |
9 | 0.9% | 100% |
10 | 0.4% | 100% |
HOSPITAL Score | LACE Index | |||||
---|---|---|---|---|---|---|
AUC | (95%CI) | p Value | AUC | (95%CI) | p Value | |
Overall | 0.59 | (0.55–0.63) | <0.001 ** | 0.59 | (0.55–0.63) | <0.001 ** |
MNA < 24 | 0.59 | (0.54–0.63) | <0.001 ** | 0.59 | (0.54–0.64) | <0.001 ** |
MNA ≥ 24 | 0.60 | (0.52–0.67) | 0.020 * | 0.58 | (0.50–0.66) | 0.052 |
ADL (upon admission) < 60 | 0.59 | (0.54–0.64) | <0.001 ** | 0.60 | (0.55–0.65) | <0.001 ** |
ADL (upon admission) ≥ 60 | 0.58 | (0.51–0.65) | 0.024 * | 0.56 | (0.50–0.63) | 0.072 |
Gait ability 0–1 | 0.58 | (0.52–0.63) | 0.003 ** | 0.57 | (0.52–0.63) | 0.005 * |
Gait ability≥ 2 | 0.58 | (0.51–0.64) | 0.019 * | 0.58 | (0.51–0.64) | 0.017 * |
Age < 85 | 0.58 | (0.53–0.63) | 0.002 ** | 0.58 | (0.53–0.63) | 0.002 ** |
Age ≥ 85 | 0.62 | (0.55–0.68) | 0.001 ** | 0.61 | (0.55–0.68) | 0.001 ** |
Male | 0.60 | (0.55–0.65) | <0.001 ** | 0.61 | (0.56–0.66) | <0.001 ** |
Female | 0.59 | (0.51–0.66) | 0.017 * | 0.55 | (0.48–0.63) | 0.133 |
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Sun, C.-H.; Chou, Y.-Y.; Lee, Y.-S.; Weng, S.-C.; Lin, C.-F.; Kuo, F.-H.; Hsu, P.-S.; Lin, S.-Y. Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score. Int. J. Environ. Res. Public Health 2023, 20, 348. https://doi.org/10.3390/ijerph20010348
Sun C-H, Chou Y-Y, Lee Y-S, Weng S-C, Lin C-F, Kuo F-H, Hsu P-S, Lin S-Y. Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score. International Journal of Environmental Research and Public Health. 2023; 20(1):348. https://doi.org/10.3390/ijerph20010348
Chicago/Turabian StyleSun, Chia-Hui, Yin-Yi Chou, Yu-Shan Lee, Shuo-Chun Weng, Cheng-Fu Lin, Fu-Hsuan Kuo, Pi-Shan Hsu, and Shih-Yi Lin. 2023. "Prediction of 30-Day Readmission in Hospitalized Older Adults Using Comprehensive Geriatric Assessment and LACE Index and HOSPITAL Score" International Journal of Environmental Research and Public Health 20, no. 1: 348. https://doi.org/10.3390/ijerph20010348