EHR readmission risk model in OPAT patients

Objective: The primary aim of this study is to determine the ability of the electronic health record-embedded EPIC Unplanned Readmission Model 1 to predict all-cause 30-day hospital unplanned readmissions in discharged patients receiving OPAT through the Duke University Heath System (DUHS) OPAT program. We then explored the impact of OPAT-specific variables on model performance.

Methods: This retrospective cohort study included patients > 18 years of age discharged to home or skilled nursing facility between July 1, 2019 - February 1, 2020 with OPAT care initiated inpatient and coordinated by the DUHS OPAT program and with at least one Epic readmission score during the index hospitalization.  Those with a planned duration of OPAT < 7 days, receiving OPAT administered in a long-term acute care facility (LTAC), or ongoing renal replacement therapy were excluded.  The relationship between the primary outcome (unplanned readmission during 30-day post-index discharge) and Epic readmission scores during the index admission (discharge and maximum) was examined using multivariable logistic regression models adjusted for additional predictors. The performance of the models was assessed with the scaled Brier score for overall model performance, the area under the receiver operating characteristics curve (C-index) for discrimination ability, calibration plot for calibration, and Hosmer-Lemeshow goodness-of-fit test for model fit.

Files include the de-identified dataset and a data dictionary.

研究目的：本研究的首要目标为验证嵌入电子健康档案的EPIC非计划再入院模型1（EPIC Unplanned Readmission Model 1）对杜克大学健康系统（DUHS）门诊肠外抗菌治疗（Outpatient Parenteral Antimicrobial Therapy，OPAT）项目中出院患者的30天全因非计划住院再入院情况的预测效能。在此基础上，本研究进一步探讨OPAT特异性变量对该模型预测性能的影响。
研究方法：本项回顾性队列研究纳入2019年7月1日至2020年2月1日期间出院至家庭或熟练护理机构的18岁以上患者，纳入标准为：住院期间启动OPAT治疗且由DUHS OPAT项目协调管理，且在本次住院期间至少完成1次EPIC再入院评分。排除标准包括：OPAT计划疗程少于7天、在长期急性护理机构（LTAC）接受OPAT治疗，以及正在接受肾脏替代治疗的患者。本研究以「本次出院后30天内发生非计划再入院」为主要结局指标，采用校正了其他预测因素的多变量逻辑回归模型，分析本次住院期间的EPIC再入院评分（出院时评分与最高评分）与主要结局之间的关联。模型性能评估采用以下指标：用于整体模型性能评估的缩放布里尔评分、用于区分能力评估的受试者工作特征曲线下面积（C指数）、用于校准性能评估的校准曲线，以及用于模型拟合度评估的Hosmer-Lemeshow拟合优度检验。
本数据集包含去标识化数据集与数据字典两份文件。