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Hospital readmission risk prediction based on claims data available at admission: a pilot study in Switzerland
  1. Beat Brüngger,
  2. Eva Blozik
  1. Department of Health Sciences, Helsana Group, Zurich, Switzerland
  1. Correspondence to Dr Eva Blozik; eva.blozik{at}helsana.ch

Abstract

Objectives Evaluating whether future studies to develop prediction models for early readmissions based on health insurance claims data available at the time of a hospitalisation are worthwhile.

Design Retrospective cohort study of hospital admissions with discharge dates between 1 January 2014 and 31 December 2016.

Setting All-cause acute care hospital admissions in the general population of Switzerland, enrolled in the Helsana Group, a large provider of Swiss mandatory health insurance.

Participants The mean age of 138 222 hospitalised adults included in the study was 60.5 years. Patients were included only with their first index hospitalisation. Patients who deceased during the follow-up period were excluded, as well as patients admitted from and/or discharged to nursing homes or rehabilitation clinics.

Measures The primary outcome was 30-day readmission rate. Area under the receiver operating characteristic curve (AUC) was used to measure the discrimination of the developed logistic regression prediction model. Candidate variables were theory based and derived from a systematic literature search.

Results We observed a 30-day readmission rate of 7.5%. Fifty-five candidate variables were identified. The final model included pharmacy-based cost group (PCG) cancer, PCG cardiac disease, PCG pain, emergency index admission, number of emergency visits, costs specialists, costs hospital outpatient, costs laboratory, costs therapeutic devices, costs physiotherapy, number of outpatient visits, sex, age group and geographical region as predictors. The prediction model achieved an AUC of 0.60 (95% CI 0.60 to 0.61).

Conclusions Based on the results of our study, it is not promising to invest resources in large-scale studies for the development of prediction tools for hospital readmissions based on health insurance claims data available at admission. The data proved appropriate to investigate the occurrence of hospitalisations and subsequent readmissions, but we did not find evidence for the potential of a clinically helpful prediction tool based on patient-sided variables alone.

  • readmission
  • claims data
  • prediction model
  • Switzerland

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors Both authors participated in the elaboration of the concept and design of the study. BB performed the statistical analysis. Both authors contributed to data interpretation. BB drafted the manuscript, EB reviewed and commented. Both authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Both authors were employed at the Helsana Group at the time of writing.

  • Ethics approval Prior to the analysis, the pre-existing raw data were anonymised in order to protect the privacy of patients and care providers. Hence, in accordance with the Swiss Federal Law on data protection, neither the consent of the insurees nor an ethics committee approval was required for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are available.

  • Patient consent for publication Not required.

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