Validating the LACE Index for Predicting 30-Day Readmission and Early Death Risks, and Preliminary Results of Integrating with the 8P Tool, among Gastroenterology Ward Patients of a Medical Center in Taiwan

LACE評估分數運用於病人出院後30日內再住院及死亡風險評估適配度暨結合8P需求評估工具初步成效驗證：以臺灣某醫學中心胃腸肝膽科為例

張政國(Cheng-Kuo Chang) ； 吳盈瑩(Ying-Ying Wu) ； 林玲玉(Ling-Yu Lin) ； 江季蓉(Chi-Jung Chiang) ； 郭守仁(Shou-Jen Kuo) ； 孫茂勝(Maw-Soan Soon)

《The Changhua Journal of Medicine》 15卷3期 (2017/09) Pp. 115-127

https://doi.org/10.6501/CJM.1503.001

摘要

Objectives: To validate the suitability of the LACE index to predict the risks of 30-day readmission or early death, and to explore the usefulness of the LACE index and the 8P risk assessment tool in reducing the 30-day readmission risk. Methods: This study utilized the 2015 claims database of gastroenterology wards of a medical center in central Taiwan. The C-statistic and logistic regression were used to analyze the discrimination, suitability, and equations of the LACE index. The Chi-square test was used to determine the usefulness of an integrated LACE index and 8P risk assessment tool in terms of reducing the 30-day readmission rate. Results: The C-statistic predictions of 30-day readmission or early death using the LACE index were 0.605 (30-day readmission or early death, p ＜ 0.001), 0.597 (30-day readmission, p ＜ 0.001), and 0.759 (risk of early death, p ＜ 0.001), and logistic regression exhibited explanatory powers of 90.8 (30-day readmission or early death, p ＜ 0.001), 91.4 (30-day readmission, p ＜ 0.001), and 98.3 (risk of early death, p ＜ 0.001). In comparison with the conventional care model, use of the integrated LACE and 8P system significantly reduced the risk of 30-day readmission (p = 0.0101). Conclusions: The LACE index is a tool for predicting early death or unplanned readmission, and has been proved to be of benefit in evaluating risk by a simple method. The information system can be used to calculate real-time scores of patients during hospitalization in a fast and accurate manner. The 8P tool can analyze patients' specific issues and arrange suitable interventions in advance. Combined, these applications can effectively reduce readmission rates in medical centers.

關鍵字

30-day readmission ； 8P screening tool ； early death ； LACE index ； risk prediction

並列摘要

目標：本研究期驗證LACE評估分數運用於非開放性醫療體系病人出院後30日內再住院及死亡風險評估之適配性。並了解導入LACE與8P制度對病人出院後30日內再住院情形是否有顯著改善。研究方法：本研究以樣本醫院胃腸肝膽內科病房之2015年健保申報資料庫住院申報案件為樣本，使用c統計量針對LACE評估工具預測之一致性進行檢定；以羅吉斯迴歸檢定LACE評估分數之適配性，並計算預測再住院或早期死亡機率之迴歸方程式；針對案件出院後30日內再住院情形進行卡方檢定，檢視導入結合工具後再住院情形是否有差異。研究結果：LACE分數用於預測個案出院後30日內再住院率或早期死亡之c統計量為0.605(出院後30日內再住院或早期死亡)、0.597(出院後30日內再住院)與0.759(早期死亡early death)，p值皆小於0.001。羅吉斯迴歸解釋力係數分別為90.8(出院後30日內再住院或早期死亡)、91.4(出院後30日內再住院)與98.3(早期死亡early death)，p值皆小於0.001。表示LACE分數於預測住院個案出院後30日內再住院或早期死亡情形之解釋力良好。另外，相較傳統照護模式，透過LACE及8P介入制度，可有效降低病人出院後30日內再住院情形(p = 0.0101)。結論：目前存在許多不同之評估病人再住院之方法，惟LACE評估系統具有相對簡易且客觀之分數，可運用資訊系統自動計算，於病人住院時即時計算分數，藉以篩選出高再住院風險之病人，結合醫師使用8P篩選工具進行深入問題評估，針對可能引發再住院之問題進行介入，無論醫院是否屬於開放性醫療體系，LACE與8P工具之結合落實，證實確可降低病人再住院情形，有效提高醫療照護品質。

並列關鍵字

出院後30日再住院 ； 8P篩選工具 ； 早期死亡 ； LACE指數 ； 風險預測