Progress (?) Toward Reducing Pediatric Readmissions

Abstract

Many children's hospitals are actively working to reduce readmissions to improve care and avoid financial penalties. We sought to determine if pediatric readmission rates have changed over time. We used data from 66 hospitals in the Inpatient Essentials Database including index hospitalizations from January, 2010 through June, 2016. Seven‐day all cause (AC) and potentially preventable readmission (PPR) rates were calculated using 3M PPR software. Total and condition‐specific quarterly AC and PPR rates were generated for each hospital and in aggregate. We included 4.52 million hospitalizations across all study years. Readmission rates did not vary over the study period. The median seven‐day PPR rate across all quarters was 2.5% (range 2.1%‐2.5%); the median seven‐day AC rate across all quarters was 5.1% (range 4.3%‐5.3%). Readmission rates for individual conditions fluctuated. Despite significant national efforts to reduce pediatric readmissions, both AC and PPR readmission rates have remained unchanged over six years.

Better Outcomes for Hospitalized Children through Safe Transitions: A Quality Improvement Project

“…But little is discussed about tools used to reduce readmissions in the pediatric population. Auger et al 11 looked to find if pediatric readmissions have changed over time and found that between January 2010 through June 2016, 7-day all-cause readmissions were unchanged despite national efforts to reduce them. Contradictorily, however, Bucholz et al 12 published in 2019 found that pediatric admissions declined from 2010 to 2016 as 30-day readmission rates increased.…”

Is It Time to Revisit Pediatric Postdischarge Home Visits for Readmissions Reduction?

“…espite concerted national efforts to decrease pediatric readmissions, recent data suggest that preventable and all-cause readmission rates of hospitalized children remain unchanged. 1 Because some readmissions may be caused by inadequate postdischarge follow-up, nurse (RN) home visits offer the prospect of addressing unresolved clinical issues after discharge and ameliorating patient and family concerns that may otherwise prompt re-presentation for acute care. Yet a recent trial of this approach, the Hospital to Home Outcomes (H2O) trial, 2 found the opposite to be true: participants receiving home nurse visits had higher reutilization rates than did participants in the control group.…”

“…In contrast to the increasing presence of hospital reimbursement penalties among state Medicaid agencies for readmissions, a shift in focus toward outcome measures that are patient-and family-centered is imperative. 1,7 If home visits are not ultimately a solution to pediatric reutilization reduction, they may nonetheless still enable families to effectively manage the concerns that families endorse following discharge, including medication safety and social hardships. 8 In summary, Riddle et al not only provided important context for the unexpected outcome of a well-designed randomized clinical trial but also provided a rich source of qualitative data that furthers our understanding of a child's discharge home from the hospital through the perspective of multiple stakeholders.…”

Pediatric Readmissions and the Quality of Hospital‐to‐Home Transitions

“…Furthermore, few (approximately 2%) qualify as potentially preventable, and pediatric readmission rates remain largely unchanged despite targeted attempts to prevent reutilization. 1,2 Nonetheless, state Medicaid agencies have continued to reduce reimbursement for hospitals based on available readmissions metrics, most commonly the Potentially Preventable Readmissions (PPR) algorithm. 1 In this issue of the Journal of Hospital Medicine, Auger et al 3 performed a retrospective study to explore four existing metrics of pediatric hospital readmissions for their ability to identify preventable and unplanned readmissions.…”

“…1,2 Nonetheless, state Medicaid agencies have continued to reduce reimbursement for hospitals based on available readmissions metrics, most commonly the Potentially Preventable Readmissions (PPR) algorithm. 1 In this issue of the Journal of Hospital Medicine, Auger et al 3 performed a retrospective study to explore four existing metrics of pediatric hospital readmissions for their ability to identify preventable and unplanned readmissions. Investigators examined 30-day readmissions (n = 1,125) from 2014-2016 across multiple subspecialties, and classified readmissions by their preventability and unplanned status with use of a validated chart abstraction tool.…”