Clinical and health care utilization variables can predict 90-day hospital re-admission in adults with Crohn's disease for point of care risk evaluation

C Dziegielewski; S Gupta; J Begum; M Pugliese; J Lombardi; Kelly E; McCurdy Jd; R Sy; Saloojee N; Ramsay T; Benchimol Ei; Murthy Sk

doi:10.1186/s12876-024-03226-7

Clinical and health care utilization variables can predict 90-day hospital re-admission in adults with Crohn's disease for point of care risk evaluation

BMC Gastroenterol. 2024 May 17;24(1):172. doi: 10.1186/s12876-024-03226-7.

Authors

C Dziegielewski¹, S Gupta², J Begum^{3

4}, M Pugliese^{3

4}, J Lombardi⁵, Kelly E^{1

3}, McCurdy Jd^{1

3

6}, R Sy^{1

3

6}, Saloojee N^{1

6}, Ramsay T³, Benchimol Ei^{7

8

9

10}, Murthy Sk^{11

12

13

14}

Affiliations

¹ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Department of Medicine, University of Toronto, Toronto, Ontario, ON, Canada.
³ Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁴ ICES uOttawa, Ottawa, ON, Canada.
⁵ Department of Medicine, McMaster University, Hamilton, Ontario, ON, Canada.
⁶ The Ottawa Hospital IBD Centre, 501 Smyth Rd, K1H 8L6, Ottawa, ON, Canada.
⁷ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
⁸ Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
⁹ ICES, Toronto, ON, Canada.
¹⁰ Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹¹ Department of Medicine, University of Ottawa, Ottawa, ON, Canada. smurthy@toh.ca.
¹² Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. smurthy@toh.ca.
¹³ ICES uOttawa, Ottawa, ON, Canada. smurthy@toh.ca.
¹⁴ The Ottawa Hospital IBD Centre, 501 Smyth Rd, K1H 8L6, Ottawa, ON, Canada. smurthy@toh.ca.

Abstract

Background: Hospital re-admission for persons with Crohn's disease (CD) is a significant contributor to morbidity and healthcare costs. We derived prediction models of risk of 90-day re-hospitalization among persons with CD that could be applied at hospital discharge to target outpatient interventions mitigating this risk.

Methods: We performed a retrospective study in persons with CD admitted between 2009 and 2016 for an acute CD-related indication. Demographic, clinical, and health services predictor variables were ascertained through chart review and linkage to administrative health databases. We derived and internally validated a multivariable logistic regression model of 90-day CD-related re-hospitalization. We selected the optimal probability cut-point to maximize Youden's index.

Results: There were 524 CD hospitalizations and 57 (10.9%) CD re-hospitalizations within 90 days of discharge. Our final model included hospitalization within the prior year (adjusted odds ratio [aOR] 3.27, 95% confidence interval [CI] 1.76-6.08), gastroenterologist consultation within the prior year (aOR 0.185, 95% CI 0.0950-0.360), intra-abdominal surgery during index hospitalization (aOR 0.216, 95% CI 0.0500-0.934), and new diagnosis of CD during index hospitalization (aOR 0.327, 95% CI 0.0950-1.13). The model demonstrated good discrimination (optimism-corrected c-statistic value 0.726) and excellent calibration (Hosmer-Lemeshow goodness-of-fit p-value 0.990). The optimal model probability cut point allowed for a sensitivity of 71.9% and specificity of 70.9% for identifying 90-day re-hospitalization, at a false positivity rate of 29.1% and false negativity rate of 28.1%.

Conclusions: Demographic, clinical, and health services variables can help discriminate persons with CD at risk of early re-hospitalization, which could permit targeted post-discharge intervention.

Keywords: Crohn’s disease; Multivariable models; Re-hospitalization.

MeSH terms

Adult
Crohn Disease* / diagnosis
Crohn Disease* / therapy
Female
Humans
Logistic Models
Male
Middle Aged
Patient Acceptance of Health Care / statistics & numerical data
Patient Readmission* / statistics & numerical data
Retrospective Studies
Risk Assessment
Young Adult