Preventing Pediatric Readmissions: Which Ones and How?

Determining preventability of pediatric readmissions using fault tree analysis

“…In addition, when assessing readmissions 7, 15, and 30 days after discharge, the algorithm classified almost the same percentage as potentially preventable, which is inconsistent with the notion that readmissions are more likely to have been preventable if they occurred closer to the initial discharge . Another study that assessed the performance of the software in the adult population reported that the algorithm performed with 85% sensitivity, but only 28% specificity …”

“…In an attempt to identify potentially preventable readmissions without using chart reviews, 3M (St. Paul, MN) developed its Potentially Preventable Readmissions software (3M‐PPR), which uses administrative data to identify which readmissions were potentially preventable. Although this automated approach is less time intensive, evidence suggests that due to a lack of nuance, the algorithm significantly overestimates the percentage of readmissions that are potentially preventable . A study that used 3M‐PPR to assess 1.7 million hospitalizations across 58 children's hospitals found that the algorithm classified 81% of sickle cell crisis and asthma readmissions, and 83% of bronchiolitis readmissions as potentially preventable .…”

“…A provision of the Affordable Care Act implemented in 2012 identified all‐cause 30‐day readmission rates as a measure of hospital quality, and as part of the Act's Hospital Readmission and Reduction Program, Medicare now penalizes hospitals with higher than expected all‐cause readmissions rates for adult patients with certain conditions by lowering reimbursements . Although readmissions are not yet commonly used to determine reimbursements for pediatric hospitals, several states are penalizing higher than expected readmission rates for Medicaid enrollees, using an imprecise algorithm to determine which readmissions resulted from low‐quality care during the index admission …”

“…Although previous studies have attempted to distinguish preventable from nonpreventable readmissions, many reported significant challenges in completing reviews efficiently, achieving consistency in how readmissions were classified, and attaining consensus on final determinations . Studies have also demonstrated that the algorithms some states are using to streamline preventability reviews and determine reimbursements overestimate the rate of potentially preventable readmissions …”

Pediatric Inpatient Readmissions in an Accountable Care Organization

“…3,4 Pediatric readmissions have also been proposed as a quality metric, although they are less common and perhaps harder to reduce than adult readmissions. [5][6][7] The 30-day readmission rate for pediatric patients ranges from 3%-13% depending on the condition studied, 5,[8][9][10][11][12] and the all-cause readmission rate ranges from 6%-13%. 11,13,14 Studies estimated that 21%-25% of pediatric readmissions were planned, 15,16 which is substantially higher than with adult readmissions (8%-10%).…”