Enhancing the Prediction of 30-Day Readmission After Percutaneous Coronary Intervention Using Data Extracted by Querying of the Electronic Health Record

Abstract

Background— Early readmission after percutaneous coronary intervention is an important quality metric, but prediction models from registry data have only moderate discrimination. We aimed to improve ability to predict 30-day readmission after percutaneous coronary intervention from a previously validated registry-based model. Methods and Results— We matched readmitted to non-readmitted patients in a 1:2 ratio by risk of readmission, and extracted unstructured and unconventional structured data from the electronic medical record, including need for medical interpretation, albumin level, medical nonadherence, previous number of emergency department visits, atrial fibrillation/flutter, syncope/presyncope, end-stage liver disease, malignancy, and anxiety. We assessed differences in rates of these conditions between cases/controls, and estimated their independent association with 30-day readmission using logistic regression conditional on matched groups. Among 9288 percutaneous coronary interventions, we matched 888 readmitted with 1776 non-readmitted patients. In univariate analysis, cases and controls were significantly different with respect to interpreter (7.9% for cases and 5.3% for controls; P =0.009), emergency department visits (1.12 for cases and 0.77 for controls; P <0.001), homelessness (3.2% for cases and 1.6% for controls; P =0.007), anticoagulation (33.9% for cases and 22.1% for controls; P <0.001), atrial fibrillation/flutter (32.7% for cases and 28.9% for controls; P =0.045), presyncope/syncope (27.8% for cases and 21.3% for controls; P <0.001), and anxiety (69.4% for cases and 62.4% for controls; P <0.001). Anticoagulation, emergency department visits, and anxiety were independently associated with readmission. Conclusions— Patient characteristics derived from review of the electronic health record can be used to refine risk prediction for hospital readmission after percutaneous coronary intervention.