Readmission Risk Based on Debility and Psychosocial Measures: The Western 9 Algorithm

Many studies have stressed the importance of psychosocial determinants of health such as food insecurity, housing instability, and education level, as important drivers of health outcomes. Western Health developed a set of nine screening questions (the Western 9) based on psychosocial measures to profile patients enrolled in the HealthLinks Chronic Care initiative. An aggregate score was then converted into a Low, Medium and High risk profiles. The aim of the study was to see if the Western 9 questions added additional discriminative power to existing risk of readmission algorithms. Results show that the inclusion of the risk profiles significantly improved model fit and calibration compared to a baseline risk model. Suggestions for further refinement include developing weighted indices for the Western 9 to improve model fit.