Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease

Dunbar, Peter J.; Hall, Matt; Hoover, Clarissa; Markham, Jessica L.; Bettenhausen, Jessica L.; Perrin, James M.; Kuhlthau, Karen; Crossman, Morgan K.; Garrity, Brigid; Berry, Jay G.

doi:10.1001/jamanetworkopen.2019.7613

Cited by 50 publications

(26 citation statements)

References 49 publications

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“…In our study, 30% of the patients readmitted to the PICU spent their entire readmission in the PICU, with no hospital days on the general ward. In addition, our data reinforce prior work that demonstrate the odds of readmission increase as the number of CCCs increases, with nearly six-fold higher odds of readmission for children with three or more CCCs compared to those without any CCC ( 19 , 20 ).…”

Section: Discussionsupporting

confidence: 88%

Resources and Costs Associated With Repeated Admissions to PICUs

Kane

Hall

Cecil

et al. 2021

Critical Care Explorations

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Objective: To determine the costs and hospital resource use from all PICU patients readmitted with a PICU stay within 12 months of hospital index discharge. Design: Cross-sectional, retrospective cohort study using Pediatric Health Information System. Setting: Fifty-two tertiary children’s hospitals. Subjects: Pediatric patients under 18 years old admitted to the PICU from January 1, 2016, to December 31, 2017. Interventions: None. Measurements and Main Results: Patient characteristics and costs of care were compared between those with readmission requiring PICU care and those with only a single PICU admission per annum. In this 2-year cohort, there were 239,157 index PICU patients of which 36,970 (15.5%) were readmitted and required PICU care during the 12 months following index admission. The total hospital cost for all index admissions and readmissions was $17.3 billion, of which 21.5% ($3.71 billion) were incurred during a readmission stay involving care in the PICU; of the 3,459,079 hospital days, 20.3% (702,200) were readmission days including those where PICU care was required. Of the readmitted patients, 11,703 (30.0%) received only PICU care, accounting for $662 million in costs and 110,215 PICU days. Although 43.6% of all costs were associated with patients who required readmission, these patients only accounted for 15.5% of the index patients and 28% of index hospitalization expenditures. More patients in the readmitted group had chronic complex conditions at index discharge compared with those not readmitted (83.9% vs 54.9%; p < 0.001). Compared with those discharged directly to home without home healthcare, patients discharged to a skilled nursing facility had 18% lower odds of readmission (odds ratio 0.82 [95% CI, 0.75–0.89]; p < 0.001) and those discharged home with home healthcare had 43% higher odds of readmission (odds ratio, 1.43 [95% CI, 1.36–1.51]; p < 0.001). Conclusions: Repeated admissions with PICU care resulted in significant direct medical costs and resource use for U.S. children’s hospitals.

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Section: Discussionsupporting

confidence: 88%

Resources and Costs Associated With Repeated Admissions to PICUs

Kane

Hall

Cecil

et al. 2021

Critical Care Explorations

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“…Being less advantaged socioeconomically accelerates the process, so in deprived areas multimorbidity occurs earlier in life 3. Children or young adults with serious congenital or acquired impairments often have multiple physical or mental illnesses,4 and the interaction between mental and physical health makes each harder to treat 5. Certain periods of life, including pregnancy, increase the probability that multiple conditions will present simultaneously.…”

mentioning

confidence: 99%

Rising to the challenge of multimorbidity

Whitty

MacEwen

Goddard

et al. 2020

BMJ

260

211

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“…Across all settings, people under 20 with one major condition, such as a genetic or congenital abnormality, often have or acquire others. For example, children with sickle-cell disease can go on to develop infections, visual problems or stroke 8 . Children and adolescents with developmental disorders can be affected by mental-health conditions as well as physical ones 9 .…”

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confidence: 99%

Map clusters of diseases to tackle multimorbidity

Whitty

Watt

2020

Nature

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ore and more people the world over have two or more long-term diseases at once-known as multimorbidity. This is the case for at least half of Europe's population aged 65 or older (more than 50 million people), for example 1. And in the United Kingdom, the proportion of the population with multi-morbidity is expected 2 to rise from 54% in 2015 to 68% in 2035. Science, and medicine, have been slow to respond to this change. One of the things that has limited the ability to address disease co-occurrences is that they are usually seen as random. In reality, diseases often cluster because of a common risk factor. Only a fraction of the many thousands People with diabetes are prone to many other comorbidities.

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Hospital Readmission of Adolescents and Young Adults With Complex Chronic Disease

Cited by 50 publications

References 49 publications

Resources and Costs Associated With Repeated Admissions to PICUs

Resources and Costs Associated With Repeated Admissions to PICUs

Rising to the challenge of multimorbidity

Map clusters of diseases to tackle multimorbidity

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