How to calculate the LACE risk score

 

The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge.

The medical literature refers to hospital readmissions as “common, expensive and often preventable” occurrences in acute-care medicine. They are now widely accepted as a quality of care barometer. Hospital readmission rates have joined the ranks of mortality and complication rates in the world of “quality of care outcomes measures”. Collectively, they are indicators that are easy to assess, and provide a basis to compare hospital performance measures.

In order to address this issue, hospitals have initiated readmission reduction strategies. A strategy, promoted by the Institute of Health Improvement, is to utilize a risk stratification tool to identify preventable readmissions. The “LACE” index is one such tool that is widely used.

The LACE index identifies patients that are at risk for readmission or death within thirty days of discharge. It incorporates four parameters.

• “L” stands for the length of stay of the index admission.
• “A” stands for the acuity of the admission. Specifically, if the patient is admitted through the Emergency Department vs. an elective admission.
• “C” stands for co-morbidities, incorporating the Charlson Co-Morbidity Index.
• “E” stands for the number of Emergency Department visits within the last 6 months.

LACE scores range from 1-19 and as mentioned above predict the rate of readmission or death within thirty days of discharge. Below is an example of how to calculate the LACE index. A score of 0 – 4 = Low; 5 – 9 = Moderate; and a score of ≥ 10 = High risk of readmission.

Multiple studies have evaluated the predictive value of the LACE index. Essentially, of the various tools available, LACE has been studied most extensively. It has been shown to have a moderate to high predictive value in identifying those patients at risk for readmission and a high predictive value in identifying those patients at risk to return the Emergency Department.

Calculating the LACE score at the time of discharge will allow the entire clinical team to identify those patients at high risk for readmission.