Precipitating factors and avoidability of 7-day readmissions after hospitalization for heart failure
Bibliographic record
Abstract
Abstract Background Hospital readmissions within 7 days after discharge are considered highly avoidable and undesirable for the patient and hospital. It is important to clarify gaps in the quality of inpatient care to identify strategies to address this problem. Aims We aimed to describe the precipitating factors and determine the potential avoidability of 7-day readmissions after hospitalization for heart failure (HF). Methods A health record audit was undertaken of patients discharged after hospitalization for HF from Calgary, Alberta hospitals. Content analysis was undertaken to identify factors precipitating readmission, and readmission’s avoidability was qualitatively examined and scored based on descriptive categories. Results Of 18,590 patients admitted to the hospital for HF during the study period, 191 HF patients were readmitted within 7 days (50% female; mean age 78 years). Potentially avoidable readmissions (57%) were due to unresolved symptoms, unaddressed social or self-care issues, adverse events from the index admission, high disability without added services, and discussions of palliative care without added services. Readmissions deemed less avoidable (43%) were due to new health issues, recurring symptoms post-stability at discharge, or refusal of care. Conclusion Only half of hospital readmissions within 7 days after HF discharge were related to HF and more than half were scored as avoidable. We provide novel criteria for identifying the avoidability of 7-day readmissions that could be used for assessing HF patients’ readiness for discharge and potentially reducing readmission rates.
Stored with the screening record, where it is evidence for the labels above.
How this classification was reachedexpand
The three-model screen
all 5,600 screened works →All three models called this out of scope.
Health record review of precipitating factors and avoidability of 7-day heart failure readmissions; a quality-of-care question about clinical services, not about research.
This health-record audit studies avoidable heart-failure readmissions, not research methodology or governance.
Health-services audit of avoidable heart-failure readmissions; clinical care quality, not research practice.
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.009 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".