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

Abstract

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.

Why do we evaluate 30‐day readmissions in general medicine? A historical perspective and contemporary data

“…A prospective cohort study in Canada also demonstrated that earlier readmissions had a greater probability of being avoidable compared to later readmissions, up to 6 months after discharge 22 . Similar results have been reported in paediatric populations with a preventable readmission rate of 28% (<7 days) versus 12.1% (8–30 days) 23 . On an even shorter timeframe, over half of 3‐day paediatric readmissions were potentially preventable due to a combination of clinical decision‐making and discharge processing 24 .…”

“…22 Similar results have been reported in paediatric populations with a preventable readmission rate of 28% (<7 days) versus 12.1% (8-30 days). 23 On an even shorter timeframe, over half of 3-day paediatric readmissions were potentially preventable due to a combination of clinical decision-making and discharge processing. 24 Taken together, these results demonstrate that the causal factors behind a patient's readmission risk are multifactorial and continue to change throughout the post-discharge timeline.…”

Racial Disparities in 7-Day Readmissions from an Adult Hospital Medicine Service

“…All-cause readmission was selected to be consistent with institutional quality metrics and national guidance from the Centers for Medicare and Medicaid Services [ 1 ]. 7-day readmission was utilized as opposed to 30-day readmission because it is more amendable hospital-based interventions prior to discharge [ 7 , 9 ].…”

“…However, less is known about disparities in 7-day readmissions. Previous studies have demonstrated that 7-day readmissions reflect a similar patient mix to 30-day readmissions but that 7-day readmissions may be a better measure of hospital care [6][7][8][9][10]. Readmissions after 7 days may be driven by factors beyond a hospital's control.…”

Predicting the risk of 7‐day readmission in late preterm infants in California: A population‐based cohort study

“…Early readmission, defined as readmission within 7‐day from discharge, is preferred to approximate preventability. 3 In the neonatal period, late preterm infants (LPTs), born at 34 to 36 completed weeks' gestation, are at two‐to‐three‐fold increased risk of readmission after birth as compared to term infants. 4 , 5 The majority of these readmissions occur shortly after birth discharge and are primarily due to hyperbilirubinemia, feeding difficulties, infection/sepsis, or respiratory complications.…”