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BMC Health Services Research
Published in: BMC Health Services Research 1/2016

Open Access 01-12-2016 | Research article

Risk-adjustment models for heart failure patients’ 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record

Authors: Jacopo Lenzi, Vera Maria Avaldi, Tina Hernandez-Boussard, Carlo Descovich, Ilaria Castaldini, Stefano Urbinati, Giuseppe Di Pasquale, Paola Rucci, Maria Pia Fantini

Published in: BMC Health Services Research | Issue 1/2016

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Abstract

Background

Hospital discharge records (HDRs) are routinely used to assess outcomes of care and to compare hospital performance for heart failure. The advantages of using clinical data from medical charts to improve risk-adjustment models remain controversial. The aim of the present study was to evaluate the additional contribution of clinical variables to HDR-based 30-day mortality and readmission models in patients with heart failure.

Methods

This retrospective observational study included all patients residing in the Local Healthcare Authority of Bologna (about 1 million inhabitants) who were discharged in 2012 from one of three hospitals in the area with a diagnosis of heart failure. For each study outcome, we compared the discrimination of the two risk-adjustment models (i.e., HDR-only model and HDR-clinical model) through the area under the ROC curve (AUC).

Results

A total of 1145 and 1025 patients were included in the mortality and readmission analyses, respectively. Adding clinical data significantly improved the discrimination of the mortality model (AUC = 0.84 vs. 0.73, p < 0.001), but not the discrimination of the readmission model (AUC = 0.65 vs. 0.63, p = 0.08).

Conclusions

We identified clinical variables that significantly improved the discrimination of the HDR-only model for 30-day mortality following heart failure. By contrast, clinical variables made little contribution to the discrimination of the HDR-only model for 30-day readmission.
Appendix
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Metadata
Title
Risk-adjustment models for heart failure patients’ 30-day mortality and readmission rates: the incremental value of clinical data abstracted from medical charts beyond hospital discharge record
Authors
Jacopo Lenzi
Vera Maria Avaldi
Tina Hernandez-Boussard
Carlo Descovich
Ilaria Castaldini
Stefano Urbinati
Giuseppe Di Pasquale
Paola Rucci
Maria Pia Fantini
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2016
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-016-1731-9

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