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A validation study of the high acuity readmission risk pediatric screen (HARRPS) tool©: Predicting readmission risk
Sarah Bradshaw1, Blair Buenning1, Samantha Chesnut1
1Children's Mercy Hospital, United States of America.
Insights
The High Acuity Readmission Risk Pediatric Screen (HARRPS) Tool was validated, showing improved accuracy in predicting pediatric readmissions. The tool was refined to two risk categories, enhancing its clinical utility for identifying at-risk children.
Area of Science:
- Pediatric healthcare research
- Clinical risk assessment tools
- Health informatics
Background:
- The High Acuity Readmission Risk Pediatric Screen (HARRPS) Tool was initially developed using retrospective data to identify pediatric readmission risk.
- This study aimed to validate the HARRPS Tool and assess the impact of including admission diagnosis on its predictive accuracy.
Purpose of the Study:
- To validate the HARRPS Tool's effectiveness in predicting 30-day pediatric readmissions.
- To determine if including admission diagnosis improves the tool's predictive performance.
- To refine the risk categorization within the HARRPS Tool.
Main Methods:
- A single-centered, retrospective chart review compared pediatric patients with and without 30-day readmissions over a 12-month period.
- The study utilized the same statistical methodology as the initial HARRPS Tool research.
- Patient data from a different subset than the initial study was analyzed.
Main Results:
- The validation study achieved a higher c-statistic (AUC) of 0.80 (without diagnosis) and 0.83 (with diagnosis) compared to the initial study's 0.68.
- The risk score interpretation was refined, consolidating moderate and high-risk categories into a single 'at-risk' category (score 3+).
- Excluding admission diagnosis resulted in a nominal decrease in predictive accuracy (c-statistic 0.80 vs. 0.83).
Conclusions:
- The HARRPS Tool, with a c-statistic of 0.80, demonstrates strong predictive performance for pediatric readmissions, outperforming other established risk assessment tools.
- Admission diagnosis was removed from the HARRPS Tool due to minimal impact on predictive accuracy.
- The tool was updated to a two-category risk stratification (low risk and at risk of readmission) for improved clinical application.
Background:
The initial research study of the High Acuity Readmission Risk Pediatric Screen (HARRPS) Tool © focused on using retrospective data to apply weighted values to the questions within the tool, identify overall risk score, and attribute risk categories (low, moderate, high risk) to the overall risk score. This study focused on validating the data from the initial study, as well as cross examining the need to include admission diagnosis within the tool.
Method:
Study was a single-centered, retrospective chart review study using a different subset of patients from the initial study. Pediatric patients with thirty-day readmissions were compared to pediatric patients without a thirty-day readmission over a twelve-month period. Utilized same statistical software and methodology from initial study to identify if readmission risk probability could be replicated with a different population.
Results:
The initial study performed in 2018 demonstrated a c-statistic score/ area under the curve (AUC) of 0.68 [95% CI: 0.67, 0.69]. In addition, the initial study demonstrated as risk score increases, the probability of readmission gradually increased until a patient had a risk score of seven or greater, at which point readmission risk plateaued. This resulted in low, moderate, and high readmission risk categories. The current study performed using data from 2019 demonstrated an improved c-statistic score / AUC of 0.83 [95% CI: 0.80, 0.87] with admission diagnosis included, and a c-statistic score / AUC of 0.80 [95% CI: 0.76, 0.83] without the admission diagnosis included. The analysis of overall risk score demonstrated a substantial difference in how to interpret final readmission risk scores. Both the initial study and validation study were consistent in demonstrating a risk score of three or less was associated with low readmission risk. However, in the validation study, there was no substantial difference between moderate or high risk, leading to updating the tool from 3 risk categories into 2 risk categories of low risk and at risk of readmission.
Conclusion:
Based on the finding from the validation study, the admission diagnosis was removed from the HARRPS Tool© as the difference in c-statistic score was nominal, and the risk categories were changed from three categories (low, moderate, high risk) to two categories of low risk (score 0-2) and at risk of readmission for a score of 3+. The ability of the HARRPS Tool© to predict readmission risk preforms best with a c-statistic = 0.80, outperforming the following tools: LACE (0.65), LACE -SDH (0.67), LACE + (0.61), Epic's readmission risk model (0.69), and SQLAPE ® (0.71) (Ryan, et al., 2021; Hwang, et al., 2021).
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