Preventability of Early Readmissions at a Children’s Hospital

Hain, Paul D.; Gay, James C.; Berutti, Tyler; Whitney, Gina M.; Wang, Wenli; Saville, Benjamin R.

doi:10.1542/peds.2012-0820

Cited by 96 publications

(85 citation statements)

References 22 publications

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“…Consistent with previous research, 12 infections accounted for 20% of the reasons for return to acute care in this study. Respiratory decompensation, however, was the primary clinical reason for unplanned readmission to acute care in this sample.…”

Section: Discussionsupporting

confidence: 92%

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

O’Brien

Dumas

Nash

et al. 2015

Hospital Pediatrics

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KEY WORDS POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential confl icts of interest to disclose. abstract OBJECTIVE: To identify the incidence, clinical reasons, and predictive factors for unplanned readmissions to acute care from a pediatric postacute care hospital. METHODS:A retrospective cohort analysis of all discharges between October 1, 2011, and September 30, 2013 (n = 298), in 1 pediatric postacute care hospital was conducted. Descriptive statistics were used to summarize the incidence and assess the clinical reasons for all readmissions to an acute care hospital. Logistic regression was used to identify predictive factors of any unplanned readmission to an acute care hospital. RESULTS:Thirty percent of all postacute care hospital discharges were unplanned readmissions to an acute care hospital. The primary clinical reasons for unplanned readmissions to acute care were respiratory decompensation (54%) and infection (20%). Requiring invasive mechanical ventilation, being <1 year of age, and having a postacute care length of stay <30 days were the 3 predictive factors.CONCLUSIONS: This is the fi rst study to examine readmission to acute care from a postacute care hospital and to identify age, length of stay, and dependence on mechanical ventilation as predictive factors. Understanding which children are likely to require an unplanned readmission may allow providers to develop strategies to minimize this occurrence.

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Section: Discussionsupporting

confidence: 92%

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

O’Brien

Dumas

Nash

et al. 2015

Hospital Pediatrics

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“…If a combined readmissions measure for common diseases was adopted, potential interventions could focus on delivering guideline-recommended care across similar diseases. Previous studies implementing care pathways and improving compliance with guidelines have reduced pediatric readmissions for bronchiolitis 35 and asthma, 36 although other studies have not shown improvements, 8,37 and thus additional work remains to be done. A pooled measure of readmissions for hospitals that admit a large number of complex chronically ill children, 38 who are known to be at risk for frequent readmissions, 2,3 could focus improvements specifically on these children during their transitions of care.…”

Section: Discussionmentioning

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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“…In the 15-day readmissions study by Hain et al, 28 readmissions after surgical hospitalizations were potentially preventable 39% of the time (significantly higher than after medical discharges [16%, P = .002]). 28 National samples by Berry et al 23 and Feudter et al 35 identified neuromuscular and neurologic disorders as the most common CCCs associated with 365-day readmissions, and they were the second most common 15-day readmissions in the study by Gay et al 31 Among studies including ACSCs, asthma was the most common ACSC 23,24,36 ; however, it is not known from these studies what fraction of the patients with asthma ACSC hospitalizations were medically complex.…”

Section: High-risk Conditionsmentioning

confidence: 98%

“…[27][28][29] Hain et al 28 devised a detailed 5-point Likert scale to rate preventability, which was independently applied by 4 physicians to chart reviews of 15-day readmission cases. They found that 20% of 15-day readmissions at their institution were potentially preventable, though overall agreement was difficult to achieve (and was specifically difficult in cases that were not clearly unpreventable).…”

Section: Preventable Hospitalizationmentioning

confidence: 99%

“…A prospective study of 248 patients, in which preventability of unscheduled ICU admissions was designated by investigators after chart review, 33 revealed that 19% of admissions in the technology assisted chronic illness group were potentially preventable. Hain et al 28 found that central venous catheter infections or ventricular shunt malfunctions were present in 8.5% of all 15-day readmissions and 43% of those rated potentially preventable.…”

Section: Medical Technology Device Complicationsmentioning

confidence: 99%

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Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) account for disproportionately high hospital use, and it is unknown if hospitalizations may be prevented. Our objective was to summarize evidence from (1) studies characterizing potentially preventable hospitalizations in CMC and (2) interventions aiming to reduce such hospitalizations. METHODS:Our data sources include Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their originations, and hand search of article bibliographies. Observational studies (n = 13) characterized potentially preventable hospitalizations, and experimental studies (n = 4) evaluated the efficacy of interventions to reduce them. Data were extracted on patient and family characteristics, medical complexity and preventable hospitalization indicators, hospitalization rates, costs, and days. Results of interventions were summarized by their effect on changes in hospital use. RESULTS:Preventable hospitalizations were measured in 3 ways: ambulatory care sensitive conditions, readmissions, or investigator-defined criteria. Postsurgical patients, those with neurologic disorders, and those with medical devices had higher preventable hospitalization rates, as did those with public insurance and nonwhite race/ethnicity. Passive smoke exposure, nonadherence to medications, and lack of follow-up after discharge were additional risks. Hospitalizations for ambulatory care sensitive conditions were less common in more complex patients. Patients receiving home visits, care coordination, chronic care-management, and continuity across settings had fewer preventable hospitalizations.CONCLUSIONS: There were a limited number of published studies. Measures for CMC and preventable hospitalizations were heterogeneous. Risk of bias was moderate due primarily to limited controlled experimental designs. Reductions in hospital use among CMC might be possible. Strategies should target primary drivers of preventable hospitalizations.

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Preventability of Early Readmissions at a Children’s Hospital

Cited by 96 publications

References 22 publications

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

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

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

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