New AHRQ Study Examines Rehospitalizations for Childhood Asthma

A new study in the November 14 issue of the Journal of Pediatrics found that about one in six children hospitalized with asthma was rehospitalized for the same condition within a year. This retrospective cohort analysis involved more than 44,000 hospitalizations at 42 children’s hospitals from 2008 to 2011. According to the study and abstract, titled “Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention,” significant variation in asthma rehospitalizations was found at the 7-, 15-, 30-, 60-, 180-, and 365-day marks of an index admission, based on patient, physician, and facility characteristics. Researchers said racial/ethnic and economic disparities were evident at the 60-day mark. Children with higher odds of being readmitted at each time interval were between the ages of 12 and 18, diagnosed with a complex chronic condition, those who had an initial hospital stay longer than 1 day, those who had a prior-year asthma admission, or those who had public insurance.

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2013 Nov 14. pii: S0022-3476(13)01231-6. doi: 10.1016/j.jpeds.2013.10.003. [Epub ahead of print]

Rehospitalization for Childhood Asthma: Timing, Variation, and Opportunities for Intervention.

Kenyon CC, Melvin PR, Chiang VW, Elliott MN, Schuster MA, Berry JG.

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Abstract

OBJECTIVE:

To assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals.

STUDY DESIGN:

Retrospective cohort analysis of 44 204 hospitalizations for children with asthma within 42 children's hospitals between July 2008 and June 2011. The main outcome measures were rehospitalization for asthma within 7, 15, 30, 60, 180, and 365 days of an index asthmaadmission.

RESULTS:

The rate of asthma rehospitalization ranged from 0.5% (n = 208) at 7 days to 17.2% (n = 7603) at 365 days. Black patients and patients with public insurance had higher odds of rehospitalization at 60 days and beyond (P ≤ .01 for both). Adolescents (12- to 18-year-old), patients with a diagnosis of a complex chronic condition, and patients with a prior year asthma admission had higher odds of rehospitalization at every time interval (P ≤ .001 for all). Significant hospital variation in case-mix adjusted rates of rehospitalization existed at each time interval (P ≤ .01 for all). Rates at 365 days were ≤10.9% for the top 10% of hospitals; if all hospitals achieved this rate, 36.6% of rehospitalizations might have been avoided.

CONCLUSIONS:

Significant variation in asthma rehospitalization rates exists across children's hospitals from 7 to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By 1 year, rehospitalizations account for 1 in 6 hospitalizations. Assessing asthmarehospitalizations at longer intervals may augment our current understanding of and approach to post-hospitalization care improvement.

KEYWORDS:

APR-DRG, All-Patient Refined Diagnosis-Related Group, CCC, Complex chronic condition, ICU, Intensive care unit, PHIS, Pediatric Health Information System