Study Finds 6.5 Percent of Patients Readmitted to Pediatric Hospitals Within 30 Days

More than 6 percent of infants and youth hospitalized over a 1-year period had unplanned readmissions within 30 days of discharge, a new study from AHRQ and CMS has found. The three health conditions with the highest readmission rates were anemia or neutropenia (23 percent); ventricular shunt procedures (18 percent); and sickle cell anemia crisis (17 percent). The majority of readmissions (9 of the top 10 diagnoses) were related to the initial cause of hospitalization. Two-thirds of the children included in this analysis of nearly 569,000 admissions to 72 children’s hospitals had at least one chronic health condition. The study also found that children with a higher number of chronic conditions had a higher likelihood of an unplanned readmission as well as significant variation in readmission rates across conditions and hospitals. The study, “Pediatric Readmission Prevalence and Variability Across Hospitals,” was published in the January 23 issue of JAMA. Select to access the abstract on PubMed.®

JAMA. 2013 Jan 23;309(4):372-80. doi: 10.1001/jama.2012.188351.

Pediatric readmission prevalence and variability across hospitals.

Berry JG, Toomey SL, Zaslavsky AM, Jha AK, Nakamura MM, Klein DJ, Feng JY, Shulman S, Chiang VK, Kaplan W, Hall M, Schuster MA.

Source

Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu

Abstract

IMPORTANCE:

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, AND PATIENTS:

We analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. 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 1 SD above and below the mean were defined as having "high" and "low" rates, respectively.

MAIN OUTCOME MEASURES:

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 procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.

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 admission 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 AND RELEVANCE:

Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.