Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa Hospital, and the Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario.
CMAJ. 2010 Apr 6;182(6):551-7. doi: 10.1503/cmaj.091117. Epub 2010 Mar 1.
Readmissions to hospital are common, costly and often preventable. An easy-to-use index to quantify the risk of readmission or death after discharge from hospital would help clinicians identify patients who might benefit from more intensive post-discharge care. We sought to derive and validate an index to predict the risk of death or unplanned readmission within 30 days after discharge from hospital to the community.
In a prospective cohort study, 48 patient-level and admission-level variables were collected for 4812 medical and surgical patients who were discharged to the community from 11 hospitals in Ontario. We used a split-sample design to derive and validate an index to predict the risk of death or nonelective readmission within 30 days after discharge. This index was externally validated using administrative data in a random selection of 1,000,000 Ontarians discharged from hospital between 2004 and 2008.
Of the 4812 participating patients, 385 (8.0%) died or were readmitted on an unplanned basis within 30 days after discharge. Variables independently associated with this outcome (from which we derived the mnemonic "LACE") included length of stay ("L"); acuity of the admission ("A"); comorbidity of the patient (measured with the Charlson comorbidity index score) ("C"); and emergency department use (measured as the number of visits in the six months before admission) ("E"). Scores using the LACE index ranged from 0 (2.0% expected risk of death or urgent readmission within 30 days) to 19 (43.7% expected risk). The LACE index was discriminative (C statistic 0.684) and very accurate (Hosmer-Lemeshow goodness-of-fit statistic 14.1, p=0.59) at predicting outcome risk.
The LACE index can be used to quantify risk of death or unplanned readmission within 30 days after discharge from hospital. This index can be used with both primary and administrative data. Further research is required to determine whether such quantification changes patient care or outcomes.
住院患者再入院是常见的、代价高昂的，而且往往是可以预防的。一个易于使用的指数，可以量化出院后再入院或死亡的风险，将有助于临床医生识别可能需要更强化出院后护理的患者。我们试图制定并验证一个指数，以预测出院后 30 天内死亡或非计划性再入院的风险。
在一项前瞻性队列研究中，我们收集了来自安大略省 11 家医院的 4812 名内科和外科患者的 48 个患者水平和入院水平的变量。我们使用分割样本设计来推导和验证一个预测出院后 30 天内死亡或非计划性再入院风险的指数。使用 2004 年至 2008 年期间出院的 100 万安大略省患者的行政数据，对该指数进行了外部验证。
在 4812 名参与的患者中，有 385 人（8.0%）在出院后 30 天内死亡或非计划再入院。与这一结果独立相关的变量（我们从这些变量中得出了“LACE”的首字母缩写）包括住院时间（“L”）；入院时的严重程度（“A”）；患者的合并症（用 Charlson 合并症指数评分衡量）（“C”）；以及急诊就诊次数（入院前 6 个月内就诊次数）（“E”）。使用 LACE 指数的分数范围从 0（预计 30 天内死亡或紧急再入院的风险为 2.0%）到 19（预计风险为 43.7%）。LACE 指数具有区分度（C 统计量 0.684），并且非常准确（Hosmer-Lemeshow 拟合优度统计量 14.1，p=0.59），可以预测结果风险。
LACE 指数可用于量化出院后 30 天内死亡或非计划性再入院的风险。该指数可用于主要数据和行政数据。需要进一步研究以确定这种量化是否会改变患者的护理或结果。
