Patient-Reported Outcome Measures Modestly Enhance Prediction of Readmission in Patients with Cirrhosis

被引:12
作者
Orman, Eric S. [1 ]
Ghabril, Marwan S. [1 ]
Desai, Archita P. [1 ]
Nephew, Lauren [1 ]
Patidar, Kavish R. [1 ]
Gao, Sujuan [2 ]
Xu, Chenjia [2 ]
Chalasani, Naga [1 ]
机构
[1] Indiana Univ Sch Med, Div Gastroenterol & Hepatol, Indianapolis, IN 46202 USA
[2] Indiana Univ Sch Med, Dept Biostat, Indianapolis, IN 46202 USA
基金
美国国家卫生研究院;
关键词
Health services; Hepatology; Hospitalization; QUALITY-OF-LIFE; EARLY HOSPITAL READMISSION; FUNCTIONAL STATUS; DEPRESSIVE SYMPTOMS; LIVER-DISEASE; HEALTH; MORTALITY; MODEL; VALIDITY; IMPACT;
D O I
10.1016/j.cgh.2021.07.032
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
BACKGROUND & AIMS: Patients with cirrhosis have high rates of hospital readmission, but prediction models are suboptimal and have not included important patient-reported outcome measures (PROMs). In a large prospective cohort, we examined the impact of PROMs on prediction of 30-day readmissions. METHODS: We performed a prospective cohort study of adults with cirrhosis admitted to a tertiary center between June 2014 and March 2020. We collected clinical information, socioeconomic status, and PROMs addressing functional status and quality of life. We used hierarchical competing risk time-to-event analysis to examine the impact of PROMs on readmission prediction. RESULTS: A total of 654 patients were discharged alive, and 247 (38%) were readmitted within 30 days. Readmission was independently associated with cerebrovascular disease, ascites, prior hospital admission, admission via the emergency department, lower albumin, higher Model for End-Stage Liver Disease, discharge with public transportation, and impaired basic activities of daily living and quality-of-life activity domain. Reduced readmission was associated with cancer, admission for infection, children at home, and impaired emotional function. Compared with a model including only clinical variables, addition of functional status and quality-of-life variables improved the area under the receiver-operating characteristic curve from 0.72 to 0.73 and 0.75, with net reclassification indices of 0.22 and 0.18, respectively. Socioeconomic variables did not significantly improve prediction compared with clinical variables alone. Compared with a model using electronically available variables only, no models improved prediction when examined with integrated discrimination improvement. CONCLUSIONS: PROMs may marginally add to the prediction of 30-day readmissions for patients with cirrhosis. Poor social support and disability are associated with readmissions and may be high-yield targets for future interventions.
引用
收藏
页码:E1426 / E1437
页数:12
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