Factors Associated With Potentially Preventable Pediatric Admissions Vary by Diagnosis: Findings From a Large State

Medford‐Davis, Laura N.; Shah, Rohan; Kennedy, Danielle; Becker, Emilie A.

doi:10.1542/hpeds.2016-0038

Cited by 9 publications

(13 citation statements)

References 27 publications

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“…Younger children were more likely to be hospitalized for an ACSC and for dehydration. This finding has already been reported and in these studies younger children were also more likely to come to the hospital without a referral[6,19]. It may be hypothesized that admitting doctors are more prone to hospitalize when the individual is an infant or young toddler, for which some clinical conditions may be more dangerous, such as, for example, a febrile neonate being at higher risk for serious bacterial infections than older children.…”

Section: Discussionsupporting

confidence: 66%

“…Although ACSCs have been less used in the pediatric population, the results of this study show the usefulness of these conditions as indicators of the burden of preventable hospitalizations. In this study context 10.5% of all pediatric hospitalizations were preventable; in previous studies performed in Europe and USA using the same definition of preventable hospitalization described in this study, prevalence of these conditions showed variable results ranging from 5% to 40%[6,7,19]. Although high, our prevalence is one of the lowest when compared with the data reported in other studies[3,6,7].…”

Section: Discussionsupporting

confidence: 46%

“…In this study context 10.5% of all pediatric hospitalizations were preventable; in previous studies performed in Europe and USA using the same definition of preventable hospitalization described in this study, prevalence of these conditions showed variable results ranging from 5% to 40%[6,7,19]. Although high, our prevalence is one of the lowest when compared with the data reported in other studies[3,6,7]. These data deserve to be highlighted, since they can reflect the quality of provision of outpatient care in the area of our study.…”

Section: Discussionmentioning

confidence: 49%

“…Very few studies performed in the United States and in some European countries have assessed pediatric hospital admission for ACSCs, reporting variable frequencies ranging from 5% to 43%[4,6,7,15]. However, Italian data are scanty and, when available, are related to certain specific diseases (eg, asthma, gastroenteritis)[8, 16,17].…”

Section: Introductionmentioning

confidence: 99%

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Preventable pediatric hospitalizations and access to primary health care in Italy

et al. 2019

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The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 49%

Section: Introductionmentioning

confidence: 99%

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Preventable pediatric hospitalizations and access to primary health care in Italy

et al. 2019

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“…14 Studies in pediatrics, however, have shown lower overall admission and 30-day readmission rates and potentially less preventability. [15][16][17] Hence, the 30-day readmission rate may have limited utility as a quality metric in the pediatric population.…”

mentioning

confidence: 99%

Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children’s Hospital

Gardner

Vaz²,

Foster³

et al. 2020

Hospital Pediatrics

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BACKGROUND AND OBJECTIVES: The 30-day readmission rate is a common quality metric used by Medicare for adult patients. However, studies in pediatrics have shown lower readmission rates and potentially less preventability. Therefore, some question the utility of the 30-day readmission time frame in pediatrics. Our objective was to describe the characteristics of patients readmitted within 30 days of discharge over a 1-year period and determine the preventability of readmissions occurring 0 to 7 vs 8 to 30 days after discharge from a pediatric hospitalist service at an academic children's hospital. METHODS: Retrospective chart review and hospital administrative data were used to gather medical characteristics, demographics, and process-level metrics for readmitted patients between July 1, 2015, and June 30, 2016. All readmissions were reviewed by 2 senior authors and assigned a preventability category. Subgroup analysis comparing preventability in 0-to-7-and 8-to-30-day readmissions groups was performed. Qualitative thematic analysis was performed on readmissions deemed preventable. RESULTS: Of 1523 discharges that occurred during the study period, 49 patients, with 65 distinct readmission encounters, were readmitted for an overall 30-day readmission rate of 4.3% (65 of 1523). Twenty-eight percent (9 of 32) of readmissions within 7 days of discharge and 12.1% (4 of 33) occurring 8 to 30 days after discharge were deemed potentially preventable (P 5 .13). Combined, the 30-day preventable readmission rate was 20% (13 of 65). CONCLUSIONS: We identified a possible association between preventability and time to readmission. If confirmed by larger studies, the 7-day, rather than 30-day, time frame may represent a better quality metric for readmitted pediatric patients.

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A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions

et al. 2018

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IMPORTANCE Robust laboratory use data are lacking to support the general assumption that teaching hospitals with trainees routinely order more laboratory tests for inpatients than do nonteaching hospitals.OBJECTIVE To quantify differences in the use of laboratory tests between teaching and nonteaching hospitals. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was performed using a statewide database to identify hospitalizations with a primary diagnosis of bacterial pneumonia or cellulitis from January 1, 2014, to June 30, 2015, at teaching and nonteaching hospitals with 100 or more hospitalizations of each condition. Patients included were adult inpatients with a primary diagnosis of bacterial pneumonia (n = 24 118) or cellulitis (n = 19 211); patients excluded were those with an intensive care unit stay, transfer from another hospital, or a length of stay that was 2 SDs or more of the condition's mean length of stay. MAIN OUTCOMES AND MEASURESMean laboratory tests per day stratified by illness severity, as well as factors associated with laboratory use rates.RESULTS A total of 43 329 hospitalized patients (20493 women and 22836 men) had a principal diagnosis of bacterial pneumonia or cellulitis across 11 major teaching hospitals, 12 minor teaching hospitals, and 73 nonteaching hospitals in Texas. Mean number of laboratory tests per day varied significantly by hospital type and was highest for major teaching hospitals for both conditions (bacterial pneumonia: major teaching hospitals, 13.21; 95% CI, 12.91-13.51; nonteaching hospitals, 8.92; 95% CI, 8.84-9.00; P < .001; cellulitis: major teaching hospitals, 10.43; 95% CI, 10.16-10.70; nonteaching hospitals, 7.29; 95% CI, 7.22-7.36; P < .001). This association held for all levels of illness severity for both conditions, except for patients with cellulitis with the highest illness severity level. In generalized mixed linear regression models, controlling for additional patient and encounter covariates, there was a significant difference in the marginal effect of hospital teaching status on mean number of laboratory tests per day between major teaching and nonteaching hospitals (difference in marginal mean laboratory tests per day for bacterial pneumonia, 3.58; 95% CI, 2.61-4.55; P < .001; for cellulitis, 2.61; 95% CI, 1.76-3.47; P < .001). CONCLUSIONS AND RELEVANCECompared with nonteaching hospitals, patients in Texas admitted to major teaching hospitals with bacterial pneumonia or cellulitis received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics. These results support the need to examine how the culture of training environments may contribute to increased use of laboratory tests.

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Factors Associated With Potentially Preventable Pediatric Admissions Vary by Diagnosis: Findings From a Large State

Cited by 9 publications

References 27 publications

Preventable pediatric hospitalizations and access to primary health care in Italy

Preventable pediatric hospitalizations and access to primary health care in Italy

Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children’s Hospital

A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions

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