Abstract
Objective
To describe trends in unplanned 30-day all-condition hospital readmissions for children
aged 1 to 17 years between 2009 and 2014.
Methods
Analysis was conducted with the 2009–14 Nationwide Readmissions Database from the
Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.
Annual hospital readmission rates, resource use, and the most common reasons for readmission
were calculated for the 2009–14 period.
Results
The rate of readmission for children aged 1 to 17 years was essentially stable between
2009 and 2014 (5.5% in 2009 and 5.9% in 2014). In 2009, the most common reason (principal
diagnosis) for readmission was sickle cell anemia, whereas in 2014 the most common
reason was epilepsy. Pneumonia fell from the second to the sixth most common reason
for readmission over this period (from 3832 to 2418 stays). Other respiratory infections
were among the top 10 principal readmission diagnoses in 2009, but not in 2014. Septicemia
was among the 10 most common reasons for readmission in 2014, but not in 2009. Although
the average cost of index (ie, initial) stays with a subsequent readmission were similar
in 2009 and 2014, the average cost of index stays without a readmission and cost of
readmission stays increased by approximately 23%. In both 2009 and 2014, the average
cost of the index stays with a subsequent readmission was 73% to 89% higher than that
of the index stays of children who were not readmitted within 30 days. The average
cost of index stays preceding a readmission was 33% to 45% higher than average costs
for readmitted stays. In 2014, the aggregate cost of index stays plus readmissions
was $1.58 billion, with 42.9% of the costs attributable to readmissions. Regarding
the average costs and lengths of stay for the 10 most common readmission diagnoses,
in 2009 the average cost per stay for complications of devices, implants, or grafts
was nearly 5 times greater than that of asthma ($21,200 vs $4500, respectively). In
2014, average cost per stay ranged from $5500 for asthma to $39,500 for septicemia.
In 2009, the average length of stay (LOS) for complications of devices, implants,
or grafts was more than 3 three times higher than that for asthma (7.8 days vs 2.5
days, respectively), and in 2014, the average LOS for septicemia was nearly 4 times
higher than that for asthma (10.4 days vs. 2.6 days).
Conclusions
This study provides a baseline assessment for examining trends in 30-day unplanned
pediatric readmissions, an important quality metric as the provisions of the Children's
Health Insurance Program Reauthorization Act and the Affordable Care Act are changed
and implemented in the future. More than 50,000 pediatric hospital stays in 2014 occurred
within 30 days of a previous hospitalization, with an average cost of $13,800. This
report is timely, as the health care system works to become more patient-centered
and public and private payers grapple with how to pay for quality care for children.
The report provides baseline information that can be used to further explore ways
to reduce unplanned readmissions.
Keywords
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Article Info
Publication History
Published online: July 19, 2018
Accepted:
June 12,
2018
Received:
February 2,
2018
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of Academic Pediatric Association
