Abstract
Background: Identifying persons with COPD at high risk for hospital readmission allows for opportunities to provide efficient and appropriate care, which may lower readmission risk. This study examined the 30- and 60-day hospital readmission prediction of the COPD-readmission (CORE) score and added new predictors to comprise the CORE+ score. The relationship of CORE and CORE+ scores with ICU admission, endotracheal intubation, and in-hospital noninvasive ventilation (NIV) use were also investigated.
Methods: A retrospective cohort study evaluated participants with a spirometry confirmed COPD diagnosis from two academic hospitals in the Midwestern United States. CORE score included: eosinophil blood count, FEV/FVC ratio (< 0.70) and FEV (≤ 40% predicted), triple inhaler therapy, previous hospitalization, and presence of neuromuscular disease. Out-of-hospital NIV use and Charlson comorbidity index were added to comprise the CORE+ score. The association between covariates and outcomes was assessed using Chi square tests and Fisher’s exact tests. A Wilcoxon signed-rank test compared the mean ranks of CORE and CORE+ scores. CORE and CORE+ scores’ 30-and 60-day readmission predictive power was assessed using multiple logistic regression. Predictive accuracy was assessed by the area under the curve (AUC) of receiver operator characteristics (ROC) using P -value < .05 for statistical significance. Institutional review board (IRB) committee approvals were obtained.
Results: A total of 391 participants were included in the study. The study found a 22% 30-day, all-cause readmission rate and a 16%, 60-day, all-cause readmission rate. CORE+ score had better predictive accuracy than the CORE score for 30-day readmission (AUC = 0.81, 95% CI (0.76-0.86), AUC = 0.73, 95% CI (0.66-0.79), P < .001) and 60-day readmission (AUC = 0.77, 95% CI (0.71-0.83), AUC = 0.75, 95% CI (0.69-0.81), P < .001). Participants who utilized in-hospital NIV had higher mean CORE and CORE+ scores (P = .029, P = .003, respectively).
Conclusions: CORE and CORE+ scores offer accurate tools for 30- and- 60-day readmission prediction as they demonstrated moderate to excellent accuracy. Moreover, unique to this study is the discovery of a linear relationship between in-hospital NIV use and CORE and CORE+ scores. Future research could focus on validating the CORE and CORE+ scores in prospective clinical studies.
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