A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model

How to Cite

Choudhry, S. A., Li, J., Davis, D., Erdmann, C., Sikka, R., & Sutariya, B. (2013). A Public-Private Partnership Develops and Externally Validates a 30-Day Hospital Readmission Risk Prediction Model. Online Journal of Public Health Informatics, 5(2). https://doi.org/10.5210/ojphi.v5i2.4726


Introduction: Preventing the occurrence of hospital readmissions is needed to improve quality of care and foster population health across the care continuum. Hospitals are being held accountable for improving transitions of care to avert unnecessary readmissions. Advocate Health Care in Chicago and Cerner (ACC) collaborated to develop all-cause, 30-day hospital readmission risk prediction models to identify patients that need interventional resources. Ideally, prediction models should encompass several qualities: they should have high predictive ability; use reliable and clinically relevant data; use vigorous performance metrics to assess the models; be validated in populations where they are applied; and be scalable in heterogeneous populations. However, a systematic review of prediction models for hospital readmission risk determined that most performed poorly (average C-statistic of 0.66) and efforts to improve their performance are needed for widespread usage.

Methods: The ACC team incorporated electronic health record data, utilized a mixed-method approach to evaluate risk factors, and externally validated their prediction models for generalizability. Inclusion and exclusion criteria were applied on the patient cohort and then split for derivation and internal validation. Stepwise logistic regression was performed to develop two predictive models: one for admission and one for discharge. The prediction models were assessed for discrimination ability, calibration, overall performance, and then externally validated.

Results: The ACC Admission and Discharge Models demonstrated modest discrimination ability during derivation, internal and external validation post-recalibration (C-statistic of 0.76 and 0.78, respectively), and reasonable model fit during external validation for utility in heterogeneous populations.

Conclusions: The ACC Admission and Discharge Models embody the design qualities of ideal prediction models. The ACC plans to continue its partnership to further improve and develop valuable clinical models.

Key Words: 30-day All-Cause Hospital Readmission, Readmission Risk Stratification Tool, Predictive Analytics, Prediction Model, Derivation and External Validation of a Prediction Model, Clinical Decision Prediction Model

Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes. Share-alike: when posting copies or adaptations of the work, release the work under the same license as the original. For any other use of articles, please contact the copyright owner. The journal/publisher is not responsible for subsequent uses of the work, including uses infringing the above license. It is the author's responsibility to bring an infringement action if so desired by the author.