An Electronic Health Record Tool Designed to Improve Pediatric Hospital Discharge has Low Predictive Utility for Readmissions

Abstract

We developed an electronic health record tool to improve pediatric hospital discharge. This tool flags children with three components that might complicate discharge: home health, polypharmacy (≥6 medications), or non-English speaking caregiver. The tool tallies components and displays them as a composite score of 0-3 points. We describe the tool's development, implementation, and an evaluation of its predictive utility for 30-day unplanned readmissions in 29,542 discharged children. Of these children, 28% had a composite score of 1, 8% a score ≥2, and 4% were readmitted. The odds of readmission was significantly higher in children with a composite score of 1 versus 0 (odds ratio [OR]: 1.7; 95% CI, 1.5-2) and ≥2 versus 0 (OR 4.2; 95% CI 3.6-4.9). The C-statistic for this model was 0.62. Despite the positive association of the score with readmission, the tool's discriminatory performance is low. Additional research is needed to evaluate its practical benefit for improving the quality of hospital discharge.