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Rothman Index Uses EHR to Help Lower Readmission Risk

August 19, 2013
by Rajiv Leventhal
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A health risk score calculated automatically using routine data from hospital electronic health records (EHR) systems can identify patients at high risk of unplanned hospital readmission, according to recent research published in Medical Care.

The researchers evaluated the score—called the Rothman Index—as a "practical tool" for assessing readmission risk. The Rothman Index software uses information from the hospital EHR system to provide a continuously updated score indicating the likelihood of death or readmission within 30 days.

The score is calculated automatically using routine data on each patient's vital signs, routine nursing assessments, skin condition, heart rhythms, and laboratory tests. Lower Rothman Index scores (from a maximum of 100) indicate a higher risk of readmission.

Elizabeth Bradley, Ph.D., professor of public health at the Yale School of Public Health, and colleagues evaluated the ability of the Rothman Index to predict hospital readmission, based on data from more than 2,700 patients hospitalized during 2011. (During this time, doctors and nurses did not have access to the Rothman Index scores.) Sixteen percent of the patients had an unplanned readmission within 30 days after hospital discharge.

The Rothman Index was strongly associated with the risk of unplanned readmission. For patients in the highest-risk category—Rothman Index less than 70—readmission risk was more than 1 in 5. By comparison, for those in the lowest-risk category—Rothman Index 80 or higher—the risk was about 1 in 10. The Rothman Index has a maximum score of 100 points. Patients who score less than 70 points are considered high risk, patients scoring between 70 points to 79 points are considered medium risk, and patients at 80 points or above are low risk, according to the abstract.

After adjustment for other factors, patients in the highest versus lowest risk category were more than two and a half times as likely to be readmitted within 30 days of discharge. The Rothman Index predicted readmission across diagnoses and medical specialties.

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