What pediatric illnesses provoke readmission? Pediatric Readmission Prevalence & Variability Across Hospitals

What diseases provoked the highest Number

 of  Hospital Re - admissions?

• Seizure

• Bronchiolitis

• Pneumonia

My advice to parents -  Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.

January 23/30, 2013, Vol 309, No. 4 >

Original Contribution | January 23/30, 2013

Pediatric Readmission Prevalence 

and Variability Across Hospitals

Jay G. Berry, MD, MPH; Sara L. Toomey, MD, MPhil, MPH; Alan M. Zaslavsky, PhD; Ashish K. Jha, MD, MPH; Mari M. Nakamura, MD, MPH; David J. Klein, MS; Jeremy Y. Feng, BA; Shanna Shulman, PhD; Vincent K. Chiang, MD; William Kaplan, BS; Matt Hall, PhD; Mark A. Schuster, MD, PhD

JAMA. 2013;309(4):372-380. doi:10.1001/jama.2012.188351.

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ABSTRACT

ABSTRACT | METHODS | RESULTS | COMMENT | CONCLUSIONS | AUTHOR INFORMATION| REFERENCES

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.

Be vigorous in your request for rapid follow-up with specialty care after discharge from the hospital or emergency room.