Researchers from the National University of Singapore (NUS) have developed a web-based “calculator” that can predict a patient’s risk of hospital readmission in order to address the rising rates of readmission in the country.

It is estimated that 15% of patients in Singapore who have been discharged from hospitals will be readmitted into a health facility within 30 days, with each readmission driving up costs of healthcare and placing a strain on the healthcare system.

"Hospital readmissions place immense strain on the healthcare system. By cutting down the number of preventable readmissions, hospital-related healthcare costs can be significantly reduced," said project supervisor Associate Professor Alexandre Chan of the NUS Pharmacy Department.

“Our simple tool helps healthcare teams identify high-risk patients and facilitates the administration of targeted interventions for these patients -- during admission or post-discharge -- to reduce readmission rates," he added.

Researchers identified risk factors for hospital readmissions

During the process of developing the tool, the team of researchers identified risk factors of readmission by evaluating medical data and discharge information of over 300 patients aged 21 years and above from Khoo Teck Puat Hospital (KTPH) who were readmitted within 15 days.

The data collected was then validated with information retrieved from a separate cohort of 621 patients from KTPH and Singapore General Hospital (SGH) between August and September 2015.

The researchers found that the risk of hospital readmission was significantly associated with the number of medications prescribed at the time of discharge, with the risk of readmission within 15 days increasing by 6% with every additional medication prescribed.

"The practice of prescribing additional medications for discretionary use, for example mild or moderate pain, nausea and constipation, could prove counterproductive in some patients as the added complexity in the medication regimen may lead to confusion and potential errors during self-administration,” Chan explained.

“The likelihood of medication non-compliance also increases with the number of medications prescribed which could in turn lead to readmission,” he added.

Patients who were discharged to nursing homes also had a higher risk of hospital readmission.

“Patients discharged to nursing homes typically require a higher degree of post-discharge care. Ensuring that patients enter appropriate care facilities is therefore an important consideration in stemming the cycle of readmissions,” said Chan.

Intervention programmes can be developed using online calculator

The online tool that has been developed is able to calculate the patient’s chances of readmission with an accuracy rate of 65% based on factors such as the patient’s age, prescribed medications as well as prior diagnoses of medical conditions. Researchers hope that the tool will pave way for development of targeted intervention programmes, such as home visits or check-ups, for patients with higher risk of readmission. 

"Our model helps to identify patients who are at high risk of an early readmission," said researcher and PhD candidate from the NUS Department of Pharmacy, Sreemanee Raaj Dorajoo.

“These patients are most likely to benefit from interventions such as specialised discharge planning, medication counselling, caregiver training or placing patients on a home visit programme,” he added.

Chan estimates that it will take at least five years before the tool can be used in hospitals. In the meantime, discussions are in progress to incorporate the web-based tool into the existing electronic medical records system of healthcare facilities in Singapore. MIMS

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