Department of Nursing, Taipei Veterans General Hospital, Taipei 112, Taiwan.
Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 112, Taiwan.
Int J Environ Res Public Health. 2021 Jan 28;18(3):1135. doi: 10.3390/ijerph18031135.
Effectively predicting and reducing readmission in long-term home care (LTHC) is challenging. We proposed, validated, and evaluated a risk management tool that stratifies LTHC patients by LACE predictive score for readmission risk, which can further help home care providers intervene with individualized preventive plans.
A before-and-after study was conducted by a LTHC unit in Taiwan. Patients with acute hospitalization within 30 days after discharge in the unit were enrolled as two cohorts (Pre-Implement cohort in 2017 and Post-Implement cohort in 2019). LACE score performance was evaluated by calibration and discrimination (AUC, area under receiver operator characteristic (ROC) curve). The clinical utility was evaluated by negative predictive value (NPV).
There were 48 patients with 87 acute hospitalizations in Pre-Implement cohort, and 132 patients with 179 hospitalizations in Post-Implement cohort. These LTHC patients were of older age, mostly intubated, and had more comorbidities. There was a significant reduction in readmission rate by 44.7% (readmission rate 25.3% vs. 14.0% in both cohorts). Although LACE score predictive model still has room for improvement (AUC = 0.598), it showed the potential as a useful screening tool (NPV, 87.9%; 95% C.I., 74.2-94.8). The reduction effect is more pronounced in infection-related readmission.
As real-world evidence, LACE score-based risk management tool significantly reduced readmission by 44.7% in this LTHC unit. Larger scale studies involving multiple homecare units are needed to assess the generalizability of this study.
有效预测和降低长期家庭护理（LTHC）的再入院率具有挑战性。我们提出、验证和评估了一种风险管理工具，该工具根据 LACE 预测评分对再入院风险对 LTHC 患者进行分层，这可以进一步帮助家庭护理提供者通过个性化预防计划进行干预。
台湾的一个 LTHC 单位进行了一项前后对照研究。该单位出院后 30 天内有急性住院的患者被纳入两个队列（2017 年的预实施队列和 2019 年的实施后队列）。通过校准和区分（AUC，接收者操作特征（ROC）曲线下面积）评估 LACE 评分的性能。通过阴性预测值（NPV）评估临床实用性。
预实施队列中有 48 名患者 87 次急性住院，实施后队列中有 132 名患者 179 次住院。这些 LTHC 患者年龄较大，大多需要插管，合并症较多。再入院率显著降低了 44.7%（再入院率在两个队列中分别为 25.3%和 14.0%）。尽管 LACE 评分预测模型仍有改进空间（AUC=0.598），但它作为一种有用的筛选工具具有潜力（NPV，87.9%；95%CI，74.2-94.8）。感染相关再入院的降低效果更为显著。
作为真实世界的证据，基于 LACE 评分的风险管理工具在该 LTHC 单位显著降低了 44.7%的再入院率。需要进行涉及多个家庭护理单位的更大规模研究，以评估本研究的普遍性。
