The identification of post-acute patients at risk for hospital readmission: Clinical implications of the LACE index

Abstract

Readmission to the hospital is stressful and disruptive for patients and accounts for billions of dollars in healthcare spending. The reduction of unplanned all-cause readmission to an acute care hospital is a major priority of the Centers for Medicare and Medicaid Services (CMS), policymakers, nurses, and all health care providers. Research studies have focused on patients discharged from an acute-care hospital to the home setting. The LACE index scoring tool has been used to predict the risk of death or unplanned readmission within 30 days after discharge from the hospital to the home setting. This descriptive, nonexperimental research study incorporated the LACE index in the record of patients admitted to two post-acute care facilities from surrounding acute care hospitals. Data were collected between September 2015 and February 2016. There were 164 participants in the study and ages ranged from 42-98 years of age with a mean age of 74.2. Of the 164 participants, a total of 19 participants, or 11.5%, were readmitted to the hospital within a 30-day period after discharge. The most commonly identified comorbidities of diabetes without complications, congestive heart failure (CHF), chronic pulmonary disease, dementia, and cerebrovascular disease point to the layers of clinical complexity and risk when caring for older adults. This study supports further implementation of the LACE index with other clinical assessment tools that identify patients at greatest risk for an unplanned all-cause readmission to the hospital within 30 days of discharge to the post-acute care facility.