Pediatric Readmission Prevalence and Variability Across Hospitals

Abstract

Context Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge. Objective To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. Design, Setting, Patients We analyzed 568,845 admissions at 72 children's hospitals between 7/1/2009 and 6/30/2010 in the National Association of Children's Hospitals and Related Institutions Case Mix dataset. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and chronic condition indicators. Hospitals with adjusted readmission rates that were one standard deviation above and below the mean were defined as having “high” and “low” rates, respectively. Main Outcome Measure Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with ICD-9-CM procedure codes. Results The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n=36,734). Adjusted rates were 28.6% greater in hospitals with high vs. low readmission rates [7.2% (95% CI 7.1–7.2%) vs. 5.6% (95% CI 5.6-5.6%)]. For the 10 admissions diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs. low readmission rates. For example, sickle cell rates were 20.1% (95% CI 20.0–20.3%) vs. 12.7% (95% CI 12.6–12.8%) in high vs. low hospitals, respectively. Conclusions Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was wide variability in readmission rates across conditions and hospitals.

Linking Patient-Centered Medical Home and Asthma Measures Reduces Hospital Readmission Rates

“…27,[32][33][34][35] Recent multicenter data have shown that asthma was in the top 10 admission diagnoses in pediatric patients, with the highest readmission rate of 10.6% within the first year after discharge. 5,36 These studies suggest that targeting care coordination for ambulatory care-sensitive conditions, such as asthma, may also have an impact on health care expenditures. At KMCWC, the Pediatric Hospitalist Division cares for ∼85% of all inpatients.…”

Unplanned Readmissions to Acute Care From a Pediatric Postacute Care Hospital: Incidence, Clinical Reasons, and Predictive Factors

“…4,9 More specifi cally, the 30-day readmission rate for children who are typically developing and without chronic illness is 3.1%. 3 For children with a single complex chronic condition and/or technology assistance, the rate of readmission to an acute care hospital has been reported to be up to 25% within 30 days of a previous hospitalization.…”

Describing pediatric hospital discharge planning care processes using the Omaha System

“…Recognition is emerging of the need to develop a DP model to address the transitional care needs of families of children with medical complexities (Berry, Agrawal, Cohen, & Kuo, 2013). These families may have difficulties with access to care and limited resources that place them at risk for adverse outcomes such as readmissions (Berry, Toomey, et al, 2013 andSrivastava andKeren, 2013). To advance the development and testing of DP interventions for pediatric patients, a clear delineation of the actions and activities within a pediatric DP model of care is needed.…”