An Electronic Medical Record-Based Model to Predict 30-Day Risk of Readmission and Death Among HIV-Infected Inpatients

被引:48
作者
Nijhawan, Ank E. [1 ,2 ,3 ]
Clark, Christopher [1 ]
Kaplan, Richard [4 ]
Moore, Billy [1 ]
Halm, Ethan A. [2 ,3 ]
Amarasingham, Ruben [1 ,2 ,3 ]
机构
[1] Univ Texas SW Med Ctr Dallas, Ctr Clin Innovat, Div Infect Dis, Dept Med,Parkland Hlth & Hosp Syst, Dallas, TX 75235 USA
[2] Univ Texas SW Med Ctr Dallas, Dept Internal Med, Dallas, TX 75235 USA
[3] Univ Texas SW Med Ctr Dallas, Dept Clin Sci, Dallas, TX 75235 USA
[4] Texas Ctr Integrat Med Internal & Integrat Med, Dallas, TX USA
关键词
readmission; electronic medical record; HIV/AIDS; health disparities; prediction model; ACTIVE ANTIRETROVIRAL THERAPY; EARLY HOSPITAL READMISSION; HEART-FAILURE; SEXUAL TRANSMISSION; UNITED-STATES; MORTALITY; CARE; COHORT; HAART; RATES;
D O I
10.1097/QAI.0b013e31826ebc83
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: Readmission after hospitalization is costly, time-consuming, and remains common among HIV-infected individuals. We sought to use data from the Electronic Medical Record (EMR) to create a clinical, robust, multivariable model for predicting readmission risk in hospitalized HIV-infected patients. Methods: We extracted clinical and nonclinical data from the EMR of HIV-infected patients admitted to a large urban hospital between March 2006 and November 2008. These data were used to build automated predictive models for 30-day risk of readmission and death. Results: We identified 2476 index admissions among HIV-infected inpatients who were 73% males, 57% African American, with a mean age of 43 years. One-quarter were readmitted, and 3% died within 30 days of discharge. Those with a primary diagnosis during the index admission of HIV/AIDS accounted for the largest proportion of readmissions (41%), followed by those initially admitted for other infections (10%) or for oncologic (6%), pulmonary (5%), gastrointestinal (4%), and renal (3%) causes. Factors associated with readmission risk include: AIDS defining illness, CD4 <= 92, laboratory abnormalities, insurance status, homelessness, distance from the hospital, and prior emergency department visits and hospitalizations (c = 0.72; 95% confidence interval: 0.70 to 0.75). The multivariable predictors of death were CD4 < 132, abnormal liver function tests, creatinine >1.66, and hematocrit <30.8 (c = 0.79; 95% confidence interval: 0.74 to 0.84) for death. Conclusions: Readmission rates among HIV-infected patients were high. An automated model composed of factors accessible from the EMR in the first 48 hours of admission performed well in predicting the 30-day risk of readmission among HIV patients. Such a model could be used in real-time to identify HIV patients at highest risk so readmission prevention resources could be targeted most efficiently.
引用
收藏
页码:349 / 358
页数:10
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