Abstract
Objective
Despite extensive efforts, overall readmission rates at US children's hospitals have
not materially declined over the past decade, raising questions about how to direct
future efforts. Using measures of prevalence and performance variation we describe
readmission rates by condition and identify priority conditions for future intervention.
Methods
Retrospective cohort study of 49 US children's hospitals in the Pediatric Health Information
System in 2017. Conditions were classified using All Patients Refined Diagnosis Related
Groups. 30-day unadjusted and risk-adjusted readmission rates were calculated for
each hospital/condition using the Pediatric All Cause Readmission measure. We ranked
the highest volume conditions by rate variation (RV, interquartile range divided by
the median) for each condition across hospitals.
Results
The sample included 811,434 index hospitalizations with 50,196 (6.2%) 30-day readmissions.
The RV across hospitals/conditions was between 0 and 2.8 (median = 0.7). Common reasons
for admission had low RVs across hospitals, for example, bronchiolitis (readmission
rate = 5.6%, RV = 0.4), seizure (readmission rate = 6.6%, RV = 0.3), and asthma (readmission
rate = 3.1%, RV = 0.4). We identified 33 conditions with high variation in readmission
rates across hospitals, which accounted for 18% of all discharges and 11% of all pediatric
readmissions. These conditions may serve as candidates for future readmission reduction
activities.
Conclusions
Many common childhood conditions have little variation in readmission rates across
children's hospitals, suggesting limited future improvement opportunities. Conditions
with high rate variation may provide opportunities for quality improvement; however,
these conditions account for a relatively small share of total discharges suggesting
modest potential impacts on national rates.
Keywords
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Article Info
Publication History
Published online: January 22, 2022
Accepted:
January 16,
2022
Received:
July 9,
2021
Publication stage
In Press Journal Pre-ProofFootnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
