Document Detail


Pediatric readmission prevalence and variability across hospitals.
MedLine Citation:
PMID:  23340639     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Jay G Berry; Sara L Toomey; Alan M Zaslavsky; Ashish K Jha; Mari M Nakamura; David J Klein; Jeremy Y Feng; Shanna Shulman; Vincent W Chiang; Vincent K Chiang; William Kaplan; Matt Hall; Mark A Schuster
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-23     Completed Date:  2013-01-24     Revised Date:  2014-09-17    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  372-80     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Child
Child, Preschool
Chronic Disease
Diagnosis-Related Groups
Female
Hospitals, Pediatric / standards,  statistics & numerical data*
Humans
Infant
International Classification of Diseases / statistics & numerical data
Male
Patient Discharge
Patient Readmission / statistics & numerical data*
Quality Improvement
Quality Indicators, Health Care*
Retrospective Studies
Time Factors
United States
Grant Support
ID/Acronym/Agency:
K23 HD058092/HD/NICHD NIH HHS; K23 HD058092/HD/NICHD NIH HHS; U18 HS020513/HS/AHRQ HHS
Comments/Corrections
Comment In:
JAMA. 2013 Jan 23;309(4):396-8   [PMID:  23340643 ]
J Pediatr. 2013 Jul;163(1):305-6   [PMID:  23796346 ]
Erratum In:
JAMA. 2013 Mar 13;309(10):986
Note: Chiang, Vincent K [corrected to Chiang, Vincent W]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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