BMC Gastroenterology (May 2024)

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
https://doi.org/10.1186/s12876-024-03226-7
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 9

Abstract

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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.

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