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Quality of life after hospitalization predicts one-year readmission risk in a large Swiss cohort of medical in-patients

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Abstract

Purpose

Estimating the probability of readmission following hospitalization using prediction scores can be complex. Quality of life (QoL) may provide an easy and effective alternative.

Methods

Secondary analysis of the prospective “TRIAGE” cohort. All medical in-patients admitted to a Swiss tertiary care institution (2016–2019) ≥18 years with a length of stay of ≥2 days (23,309 patients) were included. EQ-5D VAS, EQ-5D index, and Barthel index were assessed at a single telephone interview 30-day after admission. Patients lost to follow-up were excluded. Readmission was defined as a non-elective hospital stay at our institution >24 h within 1 year after discharge and assessed using area under the curve (AUC) analysis with adjustment for confounders.

Results

12,842 patients (43% females, median age 68, IQR 55–78) were included. Unadjusted discrimination was modest at 0.59 (95% CI 0.56–0.62) for EQ-5D VAS. Partially adjusted discrimination (for gender) was identical. Additional adjustment for insurance, Charlson comorbidity index, length of stay, and native language increased the AUC to 0.66 (95% CI 0.63–0.69). Results were robust irrespective of time to event (12, 6 or 3 months). A cut-off in the unadjusted model of EQ-5D VAS of 55 could separate cases with a specificity of 80% and a sensitivity of 30%.

Conclusion

QoL at day 30 after admission can predict one-year readmission risk with similar precision as more intricate tools. It might help for identification of high-risk patients and the design of tailored prevention strategies.

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Data availability

Due to national laws data can only be made available on receipt of a letter of intention detailing the study hypothesis and statistical analysis plan. The steering committee of this study will discuss all requests and decide on the basis of the scientific rigor of the proposal whether data sharing is appropriate. All applicants are asked to sign a data access agreement. Please send any request to the corresponding author.

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Funding

This study was supported in part by the Swiss National Science Foundation (SNSF Professorship, PP00P3_150531/1), the Research Council of the Kantonsspital Aarau (1410.000.044) on behalf of PS, and by the “Elsa and Hugo Isler-Fonds” of the Argovian Department of Health and Social Affairs on behalf of TS. Dr. Siepmann received grants from the German Federal Ministry of Health, the Michael J. Fox Foundation, the German Parkinson Association and the Kurt Goldstein Institute that were not related to this study. Funders had no role in the design, analysis or writing of this article.

Author information

Authors and Affiliations

  1. Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland

    Tristan Struja, Daniel Koch, Sebastian Haubitz, Beat Mueller & Philipp Schuetz

  2. Division of Health Care Sciences, Dresden International University, Dresden, Germany

    Tristan Struja & Timo Siepmann

  3. Medical Faculty of the University of Basel, Basel, Switzerland

    Beat Mueller & Philipp Schuetz

  4. Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Timo Siepmann

Authors
  1. Tristan Struja
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  4. Beat Mueller
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Contributions

This work is part of a Master’s thesis of the Master’s Program in Clinical Research, Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden, Germany. TS and PS had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Tristan Struja.

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Approval was obtained from the institutional review board of Northwestern Switzerland (EKNZ) (IRB reference number: EKNZ 2012/059); the need for individual informed consent was waived due to the retrospective nature of this analysis.

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All participants had the option to withdraw from the study any time given. Also, they could answer only the question they felt appropriate.

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Struja, T., Koch, D., Haubitz, S. et al. Quality of life after hospitalization predicts one-year readmission risk in a large Swiss cohort of medical in-patients. Qual Life Res 30, 1863–1871 (2021). https://doi.org/10.1007/s11136-021-02867-5

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