Readmission to the hospital can be a physically and an emotionally exhausting experience for patients and their families. For this reason, the treating physicians should increasingly recognize post-discharge needs of patients during the hospital stay, especially for persons with an increased risk of readmission.
Patients who leave a hospital do not want to have to go back soon. "It is important to reduce rehospitalizations, as they represent a great burden for patients and their relatives," says Tristan Struja. The physician has investigated - as part of his research project funded by Swiss Cancer Research - how well the rehospitalization risk of cancer patients can be predicted.
If you know in advance who will be readmitted to the hospital within 30 days, you can look specifically for follow-up solutions, Struja says. "That could be a stay in a rehab clinic, organizing hospital-external care or transitional care." Sometimes it's also worth keeping someone in the hospital a few days longer if it means they can avoid readmission.
With his colleagues at Aarau Cantonal Hospital, Struja combed through the anonymized electronic medical records of more than 10,000 patients who were treated in the hospital from 2016 to 2018. And calculated a risk score based on the medical history - i.e., the diagnosis and any secondary diseases.
"We compared two calculation methods: a decades-old statistical method, logistic regression, with a modern method that relies on machine learning," Struja says. They found comparably good results - and (based on the large data set from Aarau) were able to correctly predict a re-entry in 70 to 80 percent of cases using both types of risk calculation.
Until now, physicians have relied primarily on gut feeling when assessing the risk of readmission. "Sometimes patients and relatives also don't want to believe the increased risk," Struja says. "It's then easier for physicians to inform if the risk assessment has been done scientifically."
"During hospitalization, people too often neglect what follows, such as a stay in a rehab clinic or transitional care."
But Struja also sees risk stratification as a valuable planning tool. Too often, post-discharge care is neglected during hospitalization, Struja's researchers write in a recently published paper (*). Yet early and efficient planning of the post-hospital period has the potential to optimize acute care resources and avoid readmissions and frequent transfers of patients.
Struja is glad that he was able to carry out his project - thanks to the donors. He is currently continuing his education in the United States, but during his time at the Aarau Cantonal Hospital, he relied on external funding for his research activities. "I am grateful to everyone who makes independent research possible with their contribution," Struja says.
In clinical research, he says, the focus is usually on testing new therapies, which is often strongly driven by the interests of pharmaceutical companies. "There is something to be gained financially from new drugs," Struja says. But many of the drugs approved in recent years would only extend the lives of cancer patients by a few months. "That's where improvements in quality of life are almost more crucial," Struja finds. "We want our patients to live not only longer, but more importantly, better to the end."
Project ID: HSR-4955-11-2019
