A recent NIHR CLAHRC West Midlands study examined a score based on co-morbidities, hospital use before the index admission, length of stay, and rate of admission – the LACE score. The findings broadly corroborate the score and previous evidence – high scores are statistically associated with risk of readmission, but predictive accuracy is low and hardly likely to improve on clinical assessment; no doctor would use such a test to identify patients. This is an inpatient study based on over 90,000 admissions. We do not want every clinical action to be codified in a score – it is a waste of time. Moreover, most readmissions are caused by a new problem. So a more sensible way forward, from my point of view, would be a general index of risk of deterioration to cover patients at all points in their journey. Would the ‘frailty index’   serve this purpose perfectly well?
— Richard Lilford, CLAHRC WM Director
- Damery S, Combes G. Evaluating the predictive strength of the LACE index in identifying patients at high risk of hospital readmission following an inpatient episode: a retrospective cohort study. BMJ Open. 2017; 7: e016921.
- Lilford RJ. Unintended Consequences of Pay-for-Performance Based on Readmissions. NIHR CLAHRC West Midlands News Blog. 13 January 2017.
- Lilford RJ. Future Trends in NHS. NIHR CLAHRC West Midlands News Blog.
- Clegg A, Bates C, Young J, et al. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing. 2016.