In a recent Client Outcomes Collaboration Program webinar, Allscripts clients shared how they have used the LACE index to identify patients who are at risk for readmission. Based on what they’ve found, they’ve taken different approaches to intervening with their patient populations.

What is LACE and how does it help prevent readmissions?

The LACE index, designed to identify patients who are at risk for readmission or death within thirty days of discharge, is based on four factors:

L – Length of stay

A – Acuity of admission

C – Co-morbidities

E – Emergency room visits

The higher a patient scores on this index, the higher the risk of returning to the hospital. Hospitals are beginning to use LACE as a tool to stratify patients based on their risk level and work to reduce unnecessary readmissions.

Many healthcare systems are working hard to address the readmission challenge, because more coordinated care benefits patients. They also want to avoid financial penalties associated with these readmissions. While some U.S. regions are beginning to improve readmission rates, it remains a significant challenge for health care.

University Hospital (UH) cuts readmission rate in half with LACE

UH Geneva Medical Center (Geneva, Ohio, U.S.A) started using the LACE index to stratify patients by risk in 2011. It incorporated the LACE tool within Allscripts Sunrise™, enabling nurses to enter data and produce a score. This score is visible on the tracking board and changes to reflect the patient’s current status throughout the hospital stay.

The initiative demonstrated that social factors play a significant role in elevating risk, and that increased patient engagement was key to long-term success. For UH high-risk patients in phase one, a Hospital to Home program helped reduce the readmission rate from 15% to 7.5% over one year.

UH Geneva Medical Center further refined its risk stratification for the second phase of the program, bringing more parameters into the tool. The goal was to focus not just on high-risk patients, but find those patients whose risk levels were rising quickly. Those patients represented 34% of the organization’s total admissions.

By initiating the risk stratification process for all patients, it heightened awareness of the medical teams to begin the process of effective care coordination after discharge. Motivational interviewing techniques with patients were key to addressing behaviors with rising-risk patients who were previously unmoved.

Other emerging approaches to using LACE

A hospital based in Newport Beach, California, U.S.A. launched a pilot program with LACE in the summer of 2015. This organization focused on pharmacists and the important clinical role they can play at discharge. They counsel patients directly to help with medication reconciliation and education.

Another hospital based in New York has used the LACE tool to stratify patients and understand patterns. The goal is to transition patients to the right level of care.

Because each patient population faces different issues, the LACE tool will reveal different things to different organizations. It’s a good way to help establish a baseline for patient populations and gain a deeper understanding of what they need.

To learn more about correlations between LACE scores and readmissions and how different organizations are using this tool, visit our Client Outcomes Collaboration Program website to view more detail.

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About the author

Salman Naqvi, MD, MPH is the Director of Client Value and Outcomes program at Allscripts. He has been with the company for more than 10 years and has led various teams across Clinical Content, Sunrise Consulting and Implementation in Acute, Emergency, Ambulatory care areas in more than 35 hospitals and healthcare systems in the United States, Canada, and Asia Pacific; and managed various Optimization and Outcomes Improvement initiatives. Born and trained as a doctor in Pakistan, Dr. Naqvi served at a Presidential Task Force on Health Sector improvements in Pakistan and has a Masters in Public Health from Harvard T.H Chan School of Public Health.

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