Hospital readmission after management of appendicitis at freestanding children's hospitals: contemporary trends and financial implications

Rice-Townsend, Samuel E.; Hall, Matthew; Barnes, Jeff N.; Baxter, Jessica K.; Rangel, Shawn J.

doi:10.1016/j.jpedsurg.2012.03.025

Cited by 77 publications

(46 citation statements)

References 41 publications

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“…The mean readmission rates we observed are consistent with previous studies 8,13,14,19 and with rates available from the HCUPnet tool. 12 Furthermore, the range of rates we observed is similar to previous studies.…”

Section: Discussionsupporting

confidence: 91%

“…Several other studies report pediatric readmission rates for multiple centers, but most were limited to freestanding children' s hospitals. 2,3,[13][14][15] Other large studies did not describe hospital-level performance variation. [16][17][18] Berry et al described hospital-level variation on 30-day readmissions for multiple conditions, but data were again limited to freestanding children' s hospitals, which the authors estimated receive no more than 25% of all pediatric admissions nationally.…”

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confidence: 99%

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Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Bardach¹,

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Readmissions have been identified as a priority area for pediatric inpatient quality measurement nationally. However, it is unknown whether readmission rates vary meaningfully across hospitals and how many hospitals would be identified as high-or low-performers. WHAT THIS STUDY ADDS:Only a few hospitals that care for children are high-or low-performers when their conditionspecific revisit rates are compared with average rates across hospitals. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. abstract OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high-and low-performing hospitals. METHODS:In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level riskstandardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.RESULTS: Thirty-day readmission rates were low (,10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had ,25 visits). The only condition with .1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%). CONCLUSIONS:We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high-or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. Pediatrics 2013;132:429-436

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Bardach¹,

et al. 2013

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“…While variations in care, resource utilization, and outcomes have been evaluated at CH, variation at NCH has not been as extensively studied [2,3,8]. We identified that over 80% of patients in the U.S. received care for appendicitis at NCH.…”

Section: Discussionmentioning

confidence: 99%

“…While some cost comparisons were made between patients with nonperforated and perforated appendicitis, the primary population in our study was hospitalizations for perforated appendicitis (5400 and 5401). In order to attempt to account for coding errors and increase sampling validity, only those patients with a length of stay (LOS) of greater than two days were considered a part of the final perforated appendicitis cohort [8].…”

Section: Case Selectionmentioning

confidence: 99%

Assessment of variation in care and outcomes for pediatric appendicitis at children's and non-children's hospitals

Tian

Heiss

Wulkan

et al. 2015

Journal of Pediatric Surgery

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“…For example, PA more commonly requires a longer course of postoperative antibiotics depending on the patient's clinical course and may lead to postoperative complications such as the development of intra-abdominal abscesses. The associated costs are also a concern with the average cost per case of complicated appendicitis being $12,300, whereas cases of uncomplicated appendicitis are approximately one-half of that amount at $6355 per case [3]. Radiology, surgery, and pathology are all specialties involved with diagnosing PA and NPA.…”

Section: Introductionmentioning

confidence: 99%