Who Gets (and Who Should Get) a Serious Illness Conversation in the Hospital? An Analysis of Readmission Risk Score in an Electronic Health Record

Myrna K. Serna, Julie Fiskio, Catherine Yoon, Savanna Plombon, Joshua R. Lakin, Jeffrey L. Schnipper, Anuj K. Dalal

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Serious Illness Conversations (SICs) explore patients’ prognostic awareness, hopes, and worries, and can help establish priorities for their care during and after hospitalization. While identifying patients who benefit from an SIC remains a challenge, this task may be facilitated by use of validated prediction scores available in most commercial electronic health records (EHRs), such as Epic’s Readmission Risk Score (RRS). We identified the RRS on admission for all hospital encounters from October 2018 to August 2019 and measured the area under the receiver operating characteristic (AUROC) curve to determine whether RRS could accurately discriminate post discharge 6-month mortality. For encounters with standardized SIC documentation matched in a 1:3 ratio to controls by sex and age (±5 years), we constructed a multivariable, paired logistic regression model and measured the odds of SIC documentation per every 10% absolute increase in RRS. RRS was predictive of 6-month mortality with acceptable discrimination (AUROC.71) and was significantly associated with SIC documentation (adjusted OR 1.42, 95% CI 1.24-1.63). An RRS >28% used to identify patients with post discharge 6-month mortality had a high specificity (89.0%) and negative predictive value (NPV) (97.0%), but low sensitivity (25.2%) and positive predictive value (PPV) (7.9%). RRS may serve as a practical EHR-based screen to exclude patients not requiring an SIC, thereby leaving a smaller cohort to be further evaluated for SIC needs using other validated tools and clinical assessment.

Original languageEnglish (US)
Pages (from-to)652-657
Number of pages6
JournalAmerican Journal of Hospice and Palliative Medicine
Volume40
Issue number6
DOIs
StatePublished - Jun 2023
Externally publishedYes

Keywords

  • MD-patient communication
  • electronic health record
  • mortality
  • palliative care
  • patient-centered care
  • readmission risk score
  • serious illness conversation

ASJC Scopus subject areas

  • General Medicine

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