Nonelective Rehospitalizations and Postdischarge Mortality: Predictive Models Suitable for Use in Real Time

Med Care. 2015 Nov;53(11):916-23. doi: 10.1097/MLR.0000000000000435.


Background: Hospital discharge planning has been hampered by the lack of predictive models.

Objective: To develop predictive models for nonelective rehospitalization and postdischarge mortality suitable for use in commercially available electronic medical records (EMRs).

Design: Retrospective cohort study using split validation.

Setting: Integrated health care delivery system serving 3.9 million members.

Participants: A total of 360,036 surviving adults who experienced 609,393 overnight hospitalizations at 21 hospitals between June 1, 2010 and December 31, 2013.

Main outcome measure: A composite outcome (nonelective rehospitalization and/or death within 7 or 30 days of discharge).

Results: Nonelective rehospitalization rates at 7 and 30 days were 5.8% and 12.4%; mortality rates were 1.3% and 3.7%; and composite outcome rates were 6.3% and 14.9%, respectively. Using data from a comprehensive EMR, we developed 4 models that can generate risk estimates for risk of the combined outcome within 7 or 30 days, either at the time of admission or at 8 AM on the day of discharge. The best was the 30-day discharge day model, which had a c-statistic of 0.756 (95% confidence interval, 0.754-0.756) and a Nagelkerke pseudo-R of 0.174 (0.171-0.178) in the validation dataset. The most important predictors-a composite acute physiology score and end of life care directives-accounted for 54% of the predictive ability of the 30-day model. Incorporation of diagnoses (not reliably available for real-time use) did not improve model performance.

Conclusions: It is possible to develop robust predictive models, suitable for use in real time with commercially available EMRs, for nonelective rehospitalization and postdischarge mortality.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Female
  • Health Status Indicators*
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical*
  • Mortality / trends*
  • Outcome Assessment, Health Care
  • Patient Discharge / statistics & numerical data*
  • Patient Readmission / statistics & numerical data*
  • Risk Assessment
  • Survivors / statistics & numerical data*
  • United States
  • Young Adult