An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service

Wallace, Sowdhamini S.; Keller, Stacey; Falco, Carla; Nead, Jennifer; Minard, Charles G.; Nag, Pratip K; Quiñonez, Ricardo

doi:10.1542/hpeds.2015-0015

Hospital Pediatrics

2015

DOI: 10.1542/hpeds.2015-0015

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An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service

Sowdhamini S. Wallace

Stacey Keller

Carla Falco

et al.

Abstract: Reliable identification of preventable pediatric readmissions using individual reviewers remains a challenge. Additional studies are needed to develop a reliable approach to identify preventable readmissions and underlying modifiable factors. A focused review of 7-day readmissions and diagnoses with high readmission rates may allow use of fewer resources.

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Cited by 24 publications

(49 citation statements)

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“…16 There were some other important results from this study. Echoing the findings by Wallace et al, 4 the authors found that the time to readmission was shorter for potentially preventable than for nonpotentially preventable readmissions (a median of 4 days versus 9 days). Potentially preventable readmissions were more likely to be causally related to the index hospitalization than nonpreventable readmissions.…”

mentioning

confidence: 80%

“…Yet, there is angst about the appropriateness of using readmission rates for payment given the lack of evidence regarding the potential preventability of these events. 1 -3 Previous studies have assessed the preventability of pediatric readmissions through medical record review 4,5 and through application of proprietary software to administrative data. 6 These studies yielded estimates of 20% (medical record review) and almost 50% (proprietary software) preventability.…”

mentioning

confidence: 99%

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Preventing Pediatric Readmissions: How Does the Hospital Fit In?

2016

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confidence: 80%

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confidence: 99%

Preventing Pediatric Readmissions: How Does the Hospital Fit In?

2016

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“…This is especially true in pediatric settings, where overall readmission rates are much lower than in adult settings, many readmissions are expected as part of a patient's planned course of care, and variation in readmission rates between hospitals is correlated with the percentage of patients with certain complex chronic conditions . Thus, there is increasing agreement that hospitals and external evaluators need to shift the focus from all‐cause readmissions to a reliable, consistent, and fair measure of potentially preventable readmissions . In addition to being a more useful quality metric, analyzing preventable readmissions will help hospitals focus resources on patients with potentially modifiable risk factors and develop meaningful quality‐improvement initiatives to improve inpatient care as well as the discharge process to prepare families for their transition to home …”

mentioning

confidence: 99%

“…Although previous studies have attempted to distinguish preventable from nonpreventable readmissions, many reported significant challenges in completing reviews efficiently, achieving consistency in how readmissions were classified, and attaining consensus on final determinations . Studies have also demonstrated that the algorithms some states are using to streamline preventability reviews and determine reimbursements overestimate the rate of potentially preventable readmissions …”

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confidence: 99%

Determining preventability of pediatric readmissions using fault tree analysis

Jonas

Devon

Ronan

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Previous studies attempting to distinguish preventable from nonpreventable readmissions reported challenges in completing reviews efficiently and consistently. OBJECTIVES (1) Examine the efficiency and reliability of a Web‐based fault tree tool designed to guide physicians through chart reviews to a determination about preventability. (2) Investigate root causes of general pediatrics readmissions and identify the percent that are preventable. DESIGN/SETTING/PATIENTS General pediatricians from The Children's Hospital of Philadelphia used a Web‐based fault tree tool to classify root causes of all general pediatrics 15‐day readmissions in 2014. INTERVENTION/MEASUREMENTS The tool guided reviewers through a logical progression of questions, which resulted in 1 of 18 root causes of readmission, 8 of which were considered potentially preventable. Twenty percent of cases were cross‐checked to measure inter‐rater reliability. RESULTS Of the 7252 discharges, 248 were readmitted, for an all‐cause general pediatrics 15‐day readmission rate of 3.4%. Of those readmissions, 15 (6.0%) were deemed potentially preventable, corresponding to 0.2% of total discharges. The most common cause of potentially preventable readmissions was premature discharge. For the 50 cross‐checked cases, both reviews resulted in the same root cause for 44 (86%) of files (κ = 0.79; 95% confidence interval: 0.60‐0.98). Completing 1 review using the tool took approximately 20 minutes. CONCLUSION The Web‐based fault tree tool helped physicians to identify root causes of hospital readmissions and classify them as either preventable or not preventable in an efficient and consistent way. It also confirmed that only a small percentage of general pediatrics 15‐day readmissions are potentially preventable. Journal of Hospital Medicine 2016;11:329–335. © 2016 Society of Hospital Medicine

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“…The study by Wallace et al 16 used chart review by 3 physicians to examine the reasons for and preventability of 204 readmissions to a pediatric hospital medicine service at a large academic medical center. Using a 4-tiered readmission classification scheme, they found that most (87%) 30-day readmissions were related to the same disease processes as the index admission.…”

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confidence: 99%

Preventing Readmissions in Children: How Do We Do That?

Berry

2015

Hospital Pediatrics

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It is frankly unbelievable that we know so little about preventing hospital readmissions in children despite (1) 60 years of readmission study and discussion across the world 1 ; (2) national endorsement of measurement and reduction of readmissions by esteemed entities such as the National Quality Forum, the Centers for Medicare and Medicare Services, and the Agency for Healthcare Research and Quality [2][3][4] ; (3) computer software designed to measure preventable readmissions 5 ; and (4) financial penalties to hospitals (including children' s hospitals) with too many readmissions.6-8 There has been tremendous fervor about readmissions in adult patients, but this fervor does not sizzle at the same amplitude in children. To begin with, children (in general) have lower readmission rates than adults.9-12 Furthermore, in children, there is neither a wealth of data correlating quality of discharge care with readmission nor a clear understanding of best practices to prevent readmissions. 13-15So what' s the big deal with readmissions in children? Should we even care about them? Of course we should. First, many children do have a problem with discharge care (eg, incorrect dosing of a medication) that negatively affects their health after discharge. The burden placed on a family (and the accompanying stress) to remedy problems and issues regarding a child' s health after discharge can be devastating. The experience of worsening health after discharge and returning for another hospitalization is always an unwelcome occurrence in the life of a child. Readmissions, like all hospitalizations, are expensive, and they expose children to the dangers of the hospital environment (eg, nosocomial pathogens, adverse events). Finally, some children, especially those with medical complexity, have readmission rates that are as high as or higher than those for adult patients. 10Central to the issue of readmissions is the supposition that something could have been done to prevent them. Although "preventable" readmissions are assumed to be common in children, their true prevalence remains unknown. Both acute and chronic pediatric illnesses that require hospital treatment may have unpredictable courses, and readmissions can and do occur despite receipt of the best transitional care. So it is imperative that we distinguish which pediatric readmissions are preventable to understand how we might avoid them. In this issue of Hospital Pediatrics, articles by Wallace et al and Brittan et al address the preventability of hospital readmissions in children.The study by Wallace et al 16 used chart review by 3 physicians to examine the reasons for and preventability of 204 readmissions to a pediatric hospital medicine service at a large academic medical center. Using a 4-tiered readmission classification scheme, they found that most (87%) 30-day readmissions were related to the same disease processes as the index admission. The authors concluded that 20% of these readmissions were the most

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An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service

Cited by 24 publications

References 28 publications

Preventing Pediatric Readmissions: How Does the Hospital Fit In?

Preventing Pediatric Readmissions: How Does the Hospital Fit In?

Determining preventability of pediatric readmissions using fault tree analysis

Preventing Readmissions in Children: How Do We Do That?

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