Hospital Readmissions: A Look At Pediatric Hospitals

Unintended hospital readmissions have become a key quality-of-care indicator. A study led by Boston Children’s Hospital looked at readmission rates at dedicated pediatric hospitals nationwide and found great variability. Findings appear in the January 23/30 issue of JAMA. Researchers say that the reasons for the varied readmission rates may include differences in hospital care, follow-up care outside of the hospital, as well as community and family factors that influence child health.

Some hospitals and their local health systems had very low readmission rates for diseases that tend to have much higher rates, says first author Jay Berry, MD, MPH, a pediatrician in the Complex Care Service at Boston Children’s Hospital. “We want to know whether there is something these hospitals and systems are doing to more effectively transition their children home.”

The study reveals the following:

• 6.5% of children had unplanned readmissions within 30 days of discharge and 39% them were readmitted within seven days. (In contrast, readmission rates at adult hospitals range from 20% to 25%.) Two-thirds of readmissions were for children with at least one chronic condition; Readmission rates were as high as 23% for certain medical conditions,
• The 30-day readmission rates varied among the 72 hospitals, ranging from 4.6% to 8.5%.
• Readmission rates were 6.9% for patients with public insurance, such as Medicaid, 5.9% for those with private insurance, and 4.5% for those with no insurance.
• Readmission rates ranged from 5.4% for children with one chronic condition to 17% for those with four or more.
• Ten conditions accounted for the highest readmission rates: anemia/neutropenia, ventricular shunt procedures, sickle-cell crisis, seizures, gastroenteritis, upper respiratory infection, pneumonia, appendectomy, bronchiolitis and asthma. These 10 conditions accounted for 28% of all readmissions. Their readmission rates were 17% to 66% higher in hospitals with higher-than-average readmission rates than in low-readmission hospitals.
• Readmission rates were higher for patients with longer hospital stays, from 4.6% for patients with a one- to two-day stay to 11.2% for patients with stays of seven days or longer.

“The variation…at different hospitals suggests that there is room to improve. The effort, though, will involve more than just hospitals. Community clinicians and organizations have a role to play as well. Parents also need support in being able to stay home with their recuperating children…There are some children with complicated medical needs who have really high readmission rates. Let’s figure out what’s going on and see if there is an opportunity to make their care transitions better,” says Berry. For more information, visit http://vectorblog.org.

Last Updated 7/11/2017

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