Enter Assessment Inputs
The calculator uses a three-column layout on large screens, two columns on smaller screens, and one column on mobile devices.
Example Data Table
| Case ID | Age | Prior Admissions | LOS | CCI | ED Visits | Medications | Summary % | Follow-up Days | Composite Score | Band |
|---|---|---|---|---|---|---|---|---|---|---|
| A-101 | 54 | 0 | 3 | 2 | 1 | 6 | 96 | 5 | 18.8 | Low |
| B-204 | 67 | 1 | 5 | 4 | 2 | 10 | 74 | 10 | 50.7 | High |
| C-318 | 78 | 2 | 6 | 5 | 2 | 12 | 82 | 14 | 72.7 | High |
| D-440 | 83 | 4 | 9 | 7 | 3 | 18 | 60 | 28 | 100 | Critical |
Formula Used
Composite Score = Σ (Normalized Factor Score × Weight)
Each factor is normalized between 0.00 and 1.00. Higher values indicate greater discharge or transition exposure. The final weighted total is shown on a 0 to 100 scale.
| Factor | Weight | How It Is Scored |
|---|---|---|
| Age | 6 | Older age bands receive higher normalized scores. |
| Prior Admissions | 16 | Frequent recent admissions increase the score sharply. |
| Length of Stay | 8 | Longer stays add transition complexity and raise the score. |
| Comorbidity Index | 14 | More complex chronic burden raises expected follow-up intensity. |
| ED Visits | 10 | Higher recent ED use increases utilization concern. |
| Medication Count | 8 | Polypharmacy raises the weighted burden score. |
| Discharge Summary Completion | 10 | Lower completion percentages increase documentation risk. |
| Follow-up Delay | 8 | Longer delays before follow-up increase the score. |
| Medication Reconciliation | 6 | Incomplete reconciliation adds full documentation risk weight. |
| Caregiver Support | 5 | Limited or absent support raises transition risk. |
| Transportation Risk | 4 | Travel barriers add follow-up and pharmacy risk. |
| Housing Stability | 5 | Temporary or unstable housing adds post-discharge exposure. |
Risk bands: 0–24 Low, 25–49 Moderate, 50–74 High, and 75–100 Critical.
How to Use This Calculator
- Enter patient, utilization, and discharge documentation details.
- Select the appropriate support, transport, and housing conditions.
- Click the assessment button to calculate the weighted score.
- Review the composite score, band, top drivers, and recommendations.
- Use the Plotly graphs to see major contributors quickly.
- Download CSV or PDF reports for audits or case reviews.
- Adjust thresholds or weights in the file if your organization uses different internal rules.
Frequently Asked Questions
1. What does this score measure?
It summarizes clinical history, utilization, medication burden, and discharge documentation into one composite score. It is a planning aid, not a diagnosis or guaranteed prediction.
2. Is this a medical diagnosis tool?
No. It supports discharge reviews, case management, and utilization planning. Clinical decisions should still rely on licensed judgment, local policy, and validated institutional models.
3. Can I change the thresholds or weights?
Yes. Edit the weight table and scoring thresholds in the file. That helps teams align the tool with payer rules, service lines, or internal review standards.
4. Why are documentation fields included?
Missing summaries, delayed follow-up, and incomplete medication reconciliation often create transition failures. These fields highlight modifiable gaps, not just fixed clinical burden.
5. What score is considered high risk?
In this template, 50 to 74 is high and 75 or above is critical. Teams can adjust these cutoffs to match internal governance or payer expectations.
6. Does this page store patient data?
Not by default. The page calculates values during the session and exports only what the user enters. Add secure storage separately if your workflow needs retention.
7. How should the graph be used?
Use it to see which factors drive the score most. That helps prioritize earlier follow-up, stronger caregiver support, or faster documentation cleanup.
8. Can this support contract or audit reviews?
Yes. It can document transition-risk logic, compare scenarios, and support audit trails in utilization review, managed care reporting, and service documentation.