Context Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge. Objective To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. Design, Setting, Patients We analyzed 568,845 admissions at 72 children's hospitals between 7/1/2009 and 6/30/2010 in the National Association of Children's Hospitals and Related Institutions Case Mix dataset. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and chronic condition indicators. Hospitals with adjusted readmission rates that were one standard deviation above and below the mean were defined as having “high” and “low” rates, respectively. Main Outcome Measure Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with ICD-9-CM procedure codes. Results The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n=36,734). Adjusted rates were 28.6% greater in hospitals with high vs. low readmission rates [7.2% (95% CI 7.1–7.2%) vs. 5.6% (95% CI 5.6-5.6%)]. For the 10 admissions diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs. low readmission rates. For example, sickle cell rates were 20.1% (95% CI 20.0–20.3%) vs. 12.7% (95% CI 12.6–12.8%) in high vs. low hospitals, respectively. Conclusions Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was wide variability in readmission rates across conditions and hospitals.

CMS uses Adult HCAHPS® scores for public reporting and pay-for-performance for most U.S. hospitals, but no publicly available standardized survey of inpatient experience of care exists for pediatrics. To fill the gap, CMS/AHRQ commissioned the development of the Consumer Assessment of Healthcare Providers and Systems Hospital Survey – Child Version (Child HCAHPS), a survey of parents/guardians of pediatric patients (<18 years old) who were recently hospitalized. This Special Article describes the development of Child HCAHPS, which included an extensive review of the literature and quality measures, expert interviews, focus groups, cognitive testing, pilot testing of the draft survey, a national field test with 69 hospitals in 34 states, psychometric analysis, and end-user testing of the final survey. We conducted extensive validity and reliability testing to determine which items would be included in the final survey instrument and to develop composite measures. We analyzed national field test data from 17,727 surveys collected from 11/12-1/14 from parents of recently hospitalized children. The final Child HCAHPS instrument has 62 items, including 39 patient experience items, 10 screeners, 12 demographic/descriptive items, and 1 open-ended item. The 39 experience items are categorized based on testing into 18 composite and single-item measures. Our composite and single-item measures demonstrated good to excellent hospital-level reliability at 300 responses per hospital. Child HCAHPS was developed to be a publicly available standardized survey of pediatric inpatient experience of care. It can be used to benchmark pediatric inpatient experience across hospitals and assist in efforts to improve the quality of inpatient care.

During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection. Pediatrics 2010;126:S19-S27

Under its health reform legislation, Massachusetts has achieved near universal insurance coverage, along with significant gains in health care access and affordability. This paper examines the impacts of health reform in Massachusetts on differences in coverage, access, and affordability for women and men. We find that both women and men gained under health reform, with the gender gap in insurance coverage narrowed as men's coverage increased relative to that of women. However, the gaps in access and affordability of care have not narrowed--women in Massachusetts continue to report more unmet need for care and problems affording care than men.

Some Medicaid-enrolled low birth weight infants are at risk for poor health supervision and poor continuity of care through failure to retain coverage. The disproportionate odds of poor health promotion among mothers of low birth weight infants explain much of this deficit. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.