Table 3. Performance of the predictive model for 30-day readmission or death.
| Cohort | Model | C-statistic And 95% CI | Brier score | Hosmer-Lemeshow goodness-of-fit test |
|---|---|---|---|---|
| All patients | Model 1: Simplified HOSPITAL score | 0.66 (0.64, 0.68) | 0.12 | 0.08 |
| Model 2: Simplified HOSPITAL score + individual SDH | 0.67 (0.65, 0.69) | 0.12 | 0.15 | |
| Model 3: Simplified HOSPITAL score + census tract SDH | 0.67 (0.65, 0.69) | 0.12 | 0.20 | |
| Model 4: Simplified HOSPITAL score + individual SDH + census tract SDH | 0.67 (0.65, 0.69) | 0.12 | 0.25 | |
| Medicaid | Model 1: Simplified HOSPITAL score | 0.70 (0.65, 0.75) | 0.09 | <0.001 |
| Model 2: Simplified HOSPITAL score + individual SDH | 0.71 (0.66, 0.76) | 0.09 | 0.006 | |
| Model 3: Simplified HOSPITAL score + census tract SDH | 0.72 (0.67, 0.77) | 0.09 | 0.002 | |
| Model 4: Simplified HOSPITAL score + individual SDH + census tract SDH | 0.73 * (0.68, 0.78) | 0.09 | 0.01 | |
| 65 and older | Model 1: Simplified HOSPITAL score | 0.66 (0.63, 0.69) | 0.11 | <0.001 |
| Model 2: Simplified HOSPITAL score + individual SDH | 0.68 * (0.65, 0.71) | 0.11 | <0.001 | |
| Model 3: Simplified HOSPITAL score + census tract SDH | 0.67 (0.63, 0.70) | 0.11 | <0.001 | |
| Model 4: Simplified HOSPITAL score + individual SDH + census tract SDH | 0.68 * (0.65, 0.71) | 0.11 | <0.001 | |
| Obese | Model 1: Simplified HOSPITAL score | 0.70 (0.63, 0.77) | 0.10 | <0.001 |
| Model 2: Simplified HOSPITAL score + individual SDH | 0.71 (0.65, 0.77) | 0.10 | <0.001 | |
| Model 3: Simplified HOSPITAL score + census tract SDH | 0.72 * (0.66, 0.79) | 0.10 | 0.001 | |
| Model 4: Simplified HOSPITAL score + individual SDH + census tract SDH | 0.73 * (0.67, 0.79) | 0.10 | 0.001 |
CI: confidence interval. SDH: social determinants of health; individual SDH include sex, race (i.e., White, African American, Asian, American Indian/Alaska Nation, Native Hawaiian/Pacific Islander, other, and unknown), ethnicity (i.e., non-Hispanic, Hispanic, and unknown/declined/other), primary language (i.e., English vs. other), marital status (i.e., partnered vs. single), and insurance type (i.e., commercial, Medicare, Medicaid, dual-eligible for Medicare and Medicaid, and other public insurance). Community-level SDH include socioeconomic status (i.e., median income, unemployment rate, % with high school or high school-equivalent diploma, % foreign born, % without insurance, and % dual-eligible); felony rate, walkability score, Gini income inequality coefficient, a composite score reflecting household composition and disability, and a composite score for minority status and language. Asterisk indicates the significance of the difference in c-statistics between model 1 and model 2–4. * P<0.05, ** P<0.01, *** P<0.001.