Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation

Abstract

Background: To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8-30 days after discharge).

Methods: Patients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions.

Results: Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003-0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060-0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009-0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028-0.459]).

Conclusions: In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.

Keywords: Acute exacerbation of COPD; COPD; Hospitalization; Readmission; Socioeconomic status.

Fig. 1

Prediction performance of the reference and optimized models on readmission within 30 days after hospitalization for COPD, according to readmission outcomes. a The receiver operating characteristic (ROC) curves for predicting overall 30-day readmissions after hospitalization for COPD. There were no material differences in the area-under-curve (AUC) between reference model (AUC, 0.57) and optimized model (AUC, 0.58). b The ROC curves for predicting early readmissions within 7 days after hospitalization for COPD. The addition of social factors to the reference model improved the AUC from 0.57 to 0.63. c The ROC curves for predicting late readmissions during 8–30 days after hospitalization for COPD. The addition of social factors to the reference model improved the AUC from 0.65 to 0.68