Exploring the value of clinical data standards to predict hospitalization of home care patients

There is a critical need to reduce hospitalizations for Medicare patients and electronic health record (EHR) home care data provide new opportunities to evaluate risk of hospitalization for patients.

The objectives of this study were to 1) develop a measure to predict risk of hospitalization among home care patients, the Hospitalization Risk Score (HRS), and 2) compare it with an existing severity of illness measure, the Charlson Index of Comorbidity (CIC).

A convenience sample of clinical data from 14 home care agencies' EHRs, representing 1,643 home care patient episodes was used for the study. The development of the HRS was based on review of the literature, and expert panel evaluation to construct the HRS. Descriptive statistics and generalized linear models were used for comparative analysis; areas under curve (AUC) values were compared for receiver operating curves (ROC), and cut points predicting hospitalization were evaluated.

The HRS for this sample ranged from 0 to 5.6, with a median of 1.25. The CIC for this sample ranged from 0 to 9 and with a median of 0. Nearly three fourths of the sample was hospitalized at an HRS of 2, and a CIC of 1. AUC values for ROC were 0.63 for HRS and 0.59 for the CIC. The ROC curves were significantly different (t = -7.59, p <0.003).

This preliminary study demonstrates the potential value of the HRS using Omaha System EHR data. There was a statistically significant difference for predicting hospitalization of home care patients with the HRS versus the CIC; however the AUC values for both were low. Continued research is needed to further refine the HRS, determine whether it is more sensitive for particular subgroups of patients, and combine it with additional risk factors in understanding rehospitalization.