Utilization of the LACE index by transitions-of-care services versus standard of care to identify patients at high risk of readmission in an academic medical center

PURPOSE: This study aimed to determine whether the LACE index (length of stay, acuity of the hospital admission, comorbidities, emergency department visits in the previous 6 months) effectively identified patients at high risk for readmission compared to identification solely by use of discharge diagnoses associated with high readmission rates. METHODS: The investigators retrospectively reviewed patient records based on predefined inclusion and exclusion criteria. The primary endpoint was the percentage of discharged patients with a LACE index score of at least 10 who received a transitions-of-care (TOC) visit compared to the percentage of discharged patients who were identified for these visits through existing methods. Secondary endpoints included the proportion of patients receiving a TOC visit by payor and the 30-day readmission rate of patients identified by LACE index vs traditional methods. RESULTS: Of the 161 patients included, 124 had a LACE index score of at least 10. While 49 of 161 patients (30.4%) received a TOC visit through existing methods, 43 of the 124 patients with a LACE index score of at least 10 (34.7%) received a TOC visit (P = 0.032). Furthermore, a higher proportion of patients with insurance other than Medicaid received TOC visits than those on Medicaid, representing a gap in patients who would benefit (P < 0.001). Overall, 36 patients were readmitted within 30 days, 33 (92%) of whom were at high risk for readmission based on LACE index score. In further evaluation, only 14 of the 36 patients who were readmitted (39%) had received a TOC visit. CONCLUSION: The LACE index potentially identified patients who could benefit from a TOC visit better than current methods. No difference was found between the methods for readmission rate, although significant limitations in study design could have affected the results. A method targeting patients for TOC visits could be explored by payors, as their patients could benefit from this service.