How Well Can Hospital Readmission Be Predicted in a Cohort of Hospitalized Children? A Retrospective, Multicenter Study

Feudtner, Chris; Levin, Jeffrey S.; Srivastava, Rajendu; Goodman, Denise M.; Slonim, Anthony D.; Sharma, Vidya; Shah, Samir S.; Pati, Susmita; Fargason, Crayton A.; Hall, Matt

doi:10.1542/peds.2007-3395

Cited by 152 publications

(130 citation statements)

References 34 publications

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“…Previous studies examining readmissions in children do not provide a detailed view of the dialysis population (6,7). Our objective was to examine hospital readmissions among a cohort of children receiving chronic dialysis to identify factors associated with higher rates of 30-day readmission in this vulnerable population.…”

Section: Introductionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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Background and objectives The hospital admission rate for children receiving chronic dialysis has been increasing over the last decade. Approximately one third of patients with ESRD age 0-19 years are readmitted to the hospital within 30 days of discharge. The objective of this study was to examine hospital readmissions among a cohort of children receiving chronic dialysis to identify factors associated with higher rates of 30-day readmission.Design, settings, participants, & measurements A retrospective cohort of index admissions was developed among chronic dialysis patients age 3 months to 17 years at free-standing children's hospitals reporting information to the Pediatric Hospital Information System between January 2006 and November 30, 2010, and followed until December 31, 2010. The primary outcome was any-cause 30-day readmission, and the secondary outcome was 30-day readmission for a cause similar to that of the index hospitalization.Results In this cohort, 25% of hospital admissions were followed by a readmission within 30 days. Children older than 2 years of age had a lower odds of readmission (odds ratio [OR], 0.6; 95% confidence interval [95% CI], 0.5 to 0.8). Those receiving hemodialysis had a higher risk of readmission (OR, 1.2; 95% CI, 1.0 to 1.4), and admissions .14 days were also more likely to be followed by a readmission (OR, 1.5; 95% CI, 1.1 to 2.0). Approximately 50% of the readmissions were for a similar diagnosis as the index admission; however, the specific admitting diagnosis was not associated with readmission.Conclusions A significant number of admissions among children receiving long-term dialysis are followed by readmission within 30 days. Further investigation is required to reduce the high rate of readmissions in these children.

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Section: Introductionmentioning

confidence: 99%

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Springel

Laskin

Furth

2014

Clinical Journal of the American Society of Nephrology

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“…2,5,6 Many children who experience high health care costs incur frequent hospital admissions and lengthy hospitalizations. [15][16][17][18] Previous studies have reported that hospital care accounts for as much as 80% of total health care spending in children with severe chronic conditions. 2,5,6 Spending on other health services, such as emergency department care, medications, and primary care, is much smaller.…”

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confidence: 99%

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

et al. 2016

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BACKGROUND AND OBJECTIVES: Children who experience high health care costs are increasingly enrolled in clinical initiatives to improve their health and contain costs. Hospitalization is a significant cost driver. We describe hospitalization trends for children with highest annual inpatient cost (CHIC) and identify characteristics associated with persistently high inpatient costs in subsequent years.

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“…1 In pediatrics, readmissions within a year of an index admission are common and cost more than $1 billion annually. 2,3 As a result, development of a pediatric readmissions measure has been identified as a priority for national quality reporting programs. 4,5 Adult conditionspecific readmission rates for Medicare patients are already publicly reported online in Medicare' s national quality report.…”

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confidence: 99%

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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How Well Can Hospital Readmission Be Predicted in a Cohort of Hospitalized Children? A Retrospective, Multicenter Study

Cited by 152 publications

References 34 publications

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Readmission within 30 days of Hospital Discharge among Children Receiving Chronic Dialysis

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

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