The scoring system identifies patients vulnerable to readmission

A health risk rating robotically calculated from routine data from hospital electronic health record systems can assist discover patients at high risk of unplanned readmission, a study shows.

According to a report published within the September issue of the journal Medical Care, this indicator, called the Rothman Index, may prove to be a useful gizmo in reducing the speed of avoidable hospital readmissions.

“Can Clinicians Use the Rothman Index to Target Hospital Programs and Supports for Patients at Highest Risk for Rehospitalization?” – wrote Dr. Elizabeth Bradley of the Yale School of Public Health and colleagues.

According to a press release, the Rothman Index software uses information from a hospital’s EMR system to supply a repeatedly updated rating indicating the likelihood of death or readmission inside 30 days.

The rating is calculated robotically based on standard data on each patient’s vital signs, routine nursing assessments, skin condition, heart rhythm, and laboratory tests. Lower Rothman Index scores (maximum 100) indicate a better risk of hospital readmission.

Bradley and colleagues evaluated the flexibility of the Rothman Index to predict hospital readmission using data from greater than 2,700 patients hospitalized in 2011. (At that point, doctors and nurses didn’t have access to the Rothman Index results.) within the study sample, 16% had an unplanned readmission inside 30 days of hospital discharge.

Researchers found that the Rothman Index is strongly related to the chance of unplanned hospital readmission. For patients in the best risk category? Score below 70? the chance of readmission was one in five. Compare this to those in the bottom risk category? rating 80 or higher? the chance was about one in 10.

After adjusting for other aspects, patients in the best and lowest risk categories were greater than 2.5 times more more likely to be readmitted inside 30 days of discharge. The Rothman Index predicted readmission across quite a lot of diagnoses and medical specialties.

About 20% of Medicare patients are readmitted to the hospital inside 30 days, at an estimated cost of $17 billion a yr, in accordance with the study’s background information. Medicare has begun reducing payments by as much as 2% for hospitals with high readmission rates.

According to the press release, the Rothman Index is especially precious since it is calculated robotically from routine data and doesn’t require manual data entry by busy healthcare employees. It was developed by brothers Michael and Steven Rothman in memory of their mother, who died unexpectedly 4 days after being released from hospital following heart surgery.

During their mother’s illness, the Rothman brothers were surprised to learn that the hospital’s EMR system was not generating aggregated patient health data that would have alerted doctors to undiagnosed complications occurring at discharge. Although neither brother had a medical background, each were computer scientists with experience in applying complex analytical tools to massive electronic databases.

A brand new study suggests that the Rothman Index may help reduce the speed of unplanned hospital readmissions by identifying a gaggle of patients two to thrice more more likely to be readmitted. If implemented in day by day care, the rating could provide clinicians with “a practical way to identify patients who may be at higher risk for unplanned readmission and to intervene specifically with these patients to prevent unplanned readmission.” Bradley and co-authors wrote.

“We know that the Rothman Index is associated with hospital readmissions, but we don’t know if it can be used to improve bedside decision-making when it comes to patients’ discharge dates.” Bradley added in a press release. “We also don’t know whether physicians would benefit from using it as part of determining what kind of additional home and community support could be provided at discharge.

“The answer to these questions will determine whether clinicians can prospectively use the Rothman Index to reduce readmissions and adverse events following hospitalization.”

Study abstract: http://journals.lww.com/lww-medicalcare/Abstract/2013/09000/Identifying_Patients_at_Increased_Risk_for.2.aspx.