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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References
- Advancing children's health care and outcomes through the Pediatric Quality Measures Program.Acad Pediatr. 2014; 14: S19-S32
- Measuring pediatric hospital readmission rates to drive quality improvement.Acad Pediatr. 2014; 14: S39-S46
- Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals.JAMA. 2011; 305: 682-690
- State-level child health system performance and the likelihood of readmission to children's hospitals.J Pediatr. 2010; 157: 98-102
- Pediatric readmission prevalence and variability across hospitals.JAMA. 2013; 309: 372-380
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- The association between the quality of inpatient care and early readmission: a meta-analysis of the evidence.Med Care. 1997; 35: 1044-1059
- What works in readmissions reduction: how hospitals improve performance.Med Care. 2016; 54: 600-607
- Variation in hospital discharges for ambulatory care-sensitive conditions among children.Pediatrics. 2000; 106: 942-948
- The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals.Health Serv Res. 2010; 45: 24-41
- Preventability of early readmissions at a children's hospital.Pediatrics. 2013; 131: e171-e181
- Potentially preventable 30-day hospital readmissions at a children's hospital.Pediatrics. 2016; 138 (e20154182)
- Annual report on access to and utilization of health care for children and youth in the United States—1999.Pediatrics. 2000; 105: 219-230
- Annual report on access to and utilization of health care for children and youth in the United States—2000.Ambul Pediatr. 2001; 1: 3-15
- Health care for children and youth in the United States: 2001 annual report on access, utilization, quality, and expenditures.Ambul Pediatr. 2002; 2: 419-437
- Health care for children and youth in the United States: 2002 report on trends in access, utilization, quality, and expenditures.Ambul Pediatr. 2004; 4: 131-153
- Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by income.Ambul Pediatr. 2005; 5: 6-44
- Health care for children and youth in the United States: annual report on patterns of coverage, utilization, quality, and expenditures by a county level of urban influence.Ambul Pediatr. 2006; 6: 241-264
- Annual report on health care for children and youth in the United States: focus on injury-related emergency department utilization and expenditures.Ambul Pediatr. 2008; 8: 219-240
- Annual report on health care for children and youth in the United States: racial/ethnic and socioeconomic disparities in children's health care quality.Acad Pediatr. 2010; 10: 95-118
- Annual report on health care for children and youth in the United States: focus on trends in hospital use and quality.Acad Pediatr. 2011; 11: 263-279
- Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002-2009.Acad Pediatr. 2013; 13: 191-203
- Annual report on health care for children and youth in the United States: national estimates of cost, utilization and expenditures for children with mental health conditions.Acad Pediatr. 2015; 15: 19-35
- Annual report on children's health care: dental and orthodontic utilization and expenditures for children, 2010-2012.Acad Pediatr. 2016; 16: 314-326
Healthcare Cost and Utilization Project (HCUP) Nationwide readmissions database (NRD). 2009-2014. Available at: https://www.hcup-us.ahrq.gov/nrdoverview.jsp. Accessed June 15, 2017.
Healthcare Cost and Utilization Project (HCUP) State inpatient databases (SID). Healthcare Cost and Utilization Project (HCUP). 2005-2009. Available at: https://www.hcup-us.ahrq.gov/sidoverview.jsp. Accessed June 15, 2017.
Center for Excellence for Pediatric Quality Measurement, Boston Children's Hospital. Pediatric All-Condition Readmission Measure (NQF #2393). Available at: https://www.hca.wa.gov/assets/program/pmcc-202716-pediatric-readmissions.pdf. Accessed June 15, 2017.
- Measure: Pediatric All-Condition Readmission Measure.2014 (AHRQ Pub No. 14(15)-P008-1-EF, October Available at:) (Accessed June 15, 2017)
Center for Excellence for Pediatric Quality Measurement, Boston Children's Hospital. Pediatric All-Condition Readmission Measure (NQF #2393). National Quality Forum. Available at: http://www.qualityforum.org/Measures_Reports_Tools.aspx. Accessed June 15, 2017.
- (NCHS urban-rural classification scheme for counties, 2017. Available at) (Accessed June 15, 2017)
- (2011. ICD-9-CM official guidelines for coding and reporting. Effective October 1 Available at:) (Accessed June 15, 2017)
HCUP Clinical Classifications Software (CCS) for ICD-9-CM. Healthcare Cost and Utilization Project (HCUP). Available at: www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. Accessed June 15, 2017.
HCUP Cost-to-Charge Ratio Files (CCR). Healthcare Cost and Utilization Project (HCUP), 2009-2014. Available at: www.hcup-us.ahrq.gov/db/state/costtocharge.jsp. Accessed June 15, 2017.
US Department of Commerce, Bureau of Economic Analysis. GDP and personal income. Table 1.1.4: price indexes for gross domestic product. Available at: https://www.bea.gov/iTable/iTable.cfm?reqid=19&step=2#reqid=19&step=3&isuri=1&1910=x&0=-99&1921=survey&1903=4&1904=2009&1905=2016&1906=a&1911=0. Accessed June 15, 2017.
- Hospital readmission reduction program.Circulation. 2015; 131: 1796-1803
- Children's hospitals with shorter lengths of stay do not have higher readmission rates.J Pediatr. 2013; 164: 1034-1038
- Rates and impact of potentially preventable readmissions at children's hospitals.J Pediatr. 2015; 166: 613-619
- Rehospitalization for childhood asthma: timing, variation, and opportunities for intervention.J Pediatr. 2014; 164: 300-305
- Same-hospital readmission rates as a measure of pediatric quality of care.JAMA Pediatr. 2015; 169: 905-912
- Rehospitalization after pediatric heart transplantation: incidence, indications, and outcomes.Pediatr Transplant. 2017; 21: e12857
- Children's hospital characteristics and readmission metrics.Pediatrics. 2017; 139e20161720
- Racial and ethnic differences in pediatric readmissions for common chronic conditions.J Pediatr. 2017; 186: 158-164
- Outcomes, ICU use, and length of stay in chornically ill black and white children on Medicaid and hospitalized for surgery.J Am Coll Surg. 2017; 224: 805-814
- The effect of limited English proficiency on pediatric hospital readmissions.Hosp Pediatr. 2017; 7: 1-8
- Association of social determinants with children's hospitals' preventable readmissions performance.JAMA Pediatr. 2016; 170 (358–350)
- Adding social determinant data changes children's hospitals readmission performance.J Pediatr. 2017; 186 (e1): 150-157
- Hospital characteristics associated with risk-standardized readmission rates.Med Care. 2017; 55: 528-534
National Quality Forum. Socioeconomic Status (SES) trial period. 2014–2017. Available at: http://www.qualityforum.org/SES_Trial_Period.aspx. Accessed June 15, 2017.
- Defining medically complex children for the Children's Hospital Association.(October 2013. Available at:) (Accessed June 15, 2017)
- Patterns and costs of health care use of children with medical complexity.Pediatrics. 2012; 130: e1463-e1470
- et al. Readmission and late mortality after critical illness in childhood.Pediatr Crit Care Med. 2017; 18: e112-e121
Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Pub. L. No. 111-5, 123 Stat. 226 (Feb. 17, 2009) (full-text), codified at 42 U.S.C. §§300jj et seq.; §§17901 et seq.
- Association of coded severity with readmission reduction after the hospital readmissions reduction program.JAMA Int Med. 2018; 178: 290-292
Johnston EM, Gates JA, Kenney GM. Medicaid and CHIP for children: trends in coverage, affordability, and provider access. Available at: https://www.urban.org/sites/default/files/publication/91321/2001371-medicaid-and-chip-for_children-trends-in-coverage-affordability-and-provider-access.pdf. Accessed June 15, 2017.
US Department of Health and Human Services. HHS FY 2018 Budget in Brief. Available at: https://www.hhs.gov/about/budget/fy2018/budget-in-brief/cms/chip/index.html. Accessed June 15, 2017.
- Association between postdischarge oral corticosteroid prescription fills and readmission in children with asthma.J Pediatrics. 2017; 180: 163-169
- Hospital admissions for wheezing and asthma in childhood—are they avoidable?.J Asthma. 2006; 43: 801-806
- The rate of sepsis in the national pediatric population.Clin Pediatr (Phila). 2017; 56: 1001-1007
- Readmission and late mortality after pediatric severe sepsis.Pediatrics. 2009; 123: 849-857
- Pediatric cardiac readmissions: an opportunity for quality improvement.Congenit Heart Dis. 2017; 12: 282-288
- Pediatric surgical readmissions: are they truly preventable?.J Pediatr Surg. 2017; 52: 161-165
- Team-based versus traditional primary care models and short-term outcomes after hospital discharge.CMAJ. 2017; 189: E585-E593
- Nursing-led home visits post-hospitalization for children with medical complexity.J Pediatr Nurs. 2017; 34: 10-16
- Project IMPACT pilot report: feasibility of implementing a hospital-to-home transition bundle.Pediatrics. 2017; 139e20154626
- Impact of a pharmacist-led medication review on hospital readmission in a pediatric and elderly population: study protocol for a randomized open-label controlled trial.Trials. 2017; 18: 65
- Association between pediatric home management plan of care compliance and asthma readmission.J Asthma. 2017; 54: 761-767
- Pediatric hospital discharge interventions to reduce subsequent utilization: a systematic review.J Hosp Med. 2014; 9: 251-260
- Postdischarge phone calls after pediatric hospitalization: an observational study.Hosp Pediatr. 2015; 5: 241-248
- Effect of a pediatric prescription medication discharge program on reducing hospital readmission rates.J Pediatr Pharmacol Ther. 2017; 22: 94-101
- Discharge handoff communication and pediatric readmission.J Hosp Med. 2017; 12: 29-35
- Multi-faceted quality improvement initiative to decrease pediatric asthma readmissions.J Asthma. 2017; 54: 911-918
- Association of emergency department albuterol dispensing with pediatric asthma revisits and readmissions.J Asthma. 2017; 54: 498-503
The Joint Commission. Children's asthma care home management plan of care (HMPC) document given to patient/caregiver (CAC-3). Available at: https://manual.jointcommission.org/releases/archive/TJC2010B/MIF0073.html. Accessed June 15, 2017.
- Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York.J Am Med Inform Assoc. 2017; 24: e150-e156
- Nonelective rehospitalizations and postdischarge mortality: predictive models suitable for use in real time.Med Care. 2015; 53: 916-923
- CARE award goals and facts.(Available at) (Accessed June 15, 2017)
Aykanat Girgin B, Cimete G. Rehospitalization of preterm infants according to the discharge risk level. J Spec Pediatr Nurs. doi:10.1111/jspn.12165.
- Risk of hospital readmission among infants with neonatal abstinence syndrome.Hosp Pediatr. 2015; 5: 513-519
- et al. Reasons for rehospitalization in children who had neonatal abstinence syndrome.Pediatrics. 2015; 136: e811-e820
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
