Advertisement

Annual Variation in 30-Day Risk-Adjusted Readmission Rates in U.S. Children's Hospitals

Published:December 26, 2022DOI:https://doi.org/10.1016/j.acap.2022.12.010

      Abstract

      Objective

      Reducing pediatric readmissions has become a national priority; however, the use of readmission rates as a quality metric remains controversial. The goal of this study was to examine short-term stability and long-term changes in hospital readmission rates.

      Methods

      Data from the Pediatric Health Information System were used to compare annual 30-day risk-adjusted readmission rates (RARRs) in 47 US children's hospitals from 2016 to 2017 (short-term) and 2016 to 2019 (long-term). Pearson correlation coefficients and weighted Cohen's Kappa statistics were used to measure correlation and agreement across years for hospital-level RARRs and performance quartiles.

      Results

      Median (IQR) 30-day RARRs remained stable from 7.7% (7.0–8.3) in 2016 to 7.6% (7.0–8.1) in 2019. Individual hospital RARRs in 2016 were strongly correlated with the same hospital's 2017 rate (R2 = 0.89 [95% confidence interval (CI) 0.80–0.94]) and moderately correlated with those in 2019 (R2 = 0.49 [95%CI 0.23–0.68]). Short-term RARRs (2016 vs 2017) were more highly correlated for medical conditions than surgical conditions, but correlations between long-term medical and surgical RARRs (2016 vs 2019) were similar. Agreement between RARRs was higher when comparing short-term changes (0.73 [95%CI 0.59–0.86]) than long-term changes (0.45 [95%CI 0.27–0.63]). From 2016 to 2019, RARRs increased by ≥1% in 7 (15%) hospitals and decreased by ≥1% in 6 (13%) hospitals. Only 7 (15%) hospitals experienced reductions in RARRs over the short and long-term.

      Conclusions

      Hospital-level performance on RARRs remained stable with high agreement over the short-term suggesting stability of readmission measures. There was little evidence of sustained improvement in hospital-level performance over multiple years.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Berry JG
        • Toomey SL
        • Zaslavsky AM
        • et al.
        Pediatric readmission prevalence and variability across hospitals.
        JAMA. 2013; 309: 372-380https://doi.org/10.1001/jama.2012.188351
        • Bucholz EM
        • Gay JC
        • Hall M
        • et al.
        Timing and causes of common pediatric readmissions.
        J Pediatr. 2018; 200: 240-248https://doi.org/10.1016/j.jpeds.2018.04.044
        • Berry JG
        • Hall DE
        • Kuo DZ
        • et al.
        Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals.
        JAMA. 2011; 305: 682-690https://doi.org/10.1001/jama.2011.122
        • Bardach NS
        • Vittinghoff E
        • Asteria-Peñaloza R
        • et al.
        Measuring hospital quality using pediatric readmission and revisit rates.
        Pediatrics. 2013; 132: 429-436https://doi.org/10.1542/peds.2012-3527
        • Feudtner C
        • Levin JE
        • Srivastava R
        • et al.
        How well can hospital readmission be predicted in a cohort of hospitalized children? A retrospective, multicenter study.
        Pediatrics. 2009; 123: 286-293https://doi.org/10.1542/peds.2007-3395
        • Bucholz EM
        • Toomey SL
        • Schuster MA
        Trends in pediatric hospitalizations and readmissions: 2010–2016.
        Pediatrics. 2019; 143e20181958https://doi.org/10.1542/peds.2018-1958
        • Mistry KB
        • Chesley F
        • Llanos K
        • et al.
        Advancing children's health care and outcomes through the pediatric quality measures program.
        Acad Pediatr. 2014; 14: S19-S26https://doi.org/10.1016/j.acap.2014.06.025
        • Dougherty D
        • Schiff J
        • Mangione-Smith R
        The children's health insurance program reauthorization act quality measures initiatives: Moving forward to improve measurement, care, and child and adolescent outcomes.
        Acad Pediatr. 2011; 11: S1-10https://doi.org/10.1016/j.acap.2011.02.009
      1. CHIPRA Measures by CHIPRA Categories. Agency for Healthcare Research and Quality. Rockville, MD. Accessed December 20, 2021. http://www.ahrq.gov/policymakers/chipra/pqmpmeasures.html#note6; 2012.

      2. Reducing Medicaid Readmissions in Illinois: Moving Forward Together. Naperville, IL: The Institute for Innovations in Care and Quality. Accessed December 20, 2021. http://www.ihatoday.org/uploadDocs/1/reducingmedicaidreadmissions4-9-15.pdf; 2015.

      3. Delivery System Integration.
        in: Yong P Saunders R Olsen L The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. National Academies Press, Washington, DC2010
      4. Delivery System Reform Incentive Payment (DSRIP): Measure Specification and Reporting Manual. New York State Department of Health Medicaid Redesign Team. Accessed December 20, 2021. https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/2016/docs/2016-07-25_measure_specific_rpting_manual.pdf; 2016.

        • Adirim T
        • Meade K
        • Mistry K
        A new era in quality measurement: The development and application of quality measures.
        Pediatrics. 2017; 139e20163442https://doi.org/10.1542/peds.2016-3442
      5. Boutwell A, Jencks S, Nielsen GA, et al. STate Action on Avoidable Rehospitalizations (STAAR) Initiative. Cambridge, MA.. Accessed December 20, 2021. http://www.ihi.org/engage/initiatives/completed/STAAR/Documents/STAARStateBasedStrategy.pdf; 2009.

      6. Children's Hospitals’ Solutions for Patient Safety Network (SPS Network) Agency for Healthcare Research and Quality. Rockville, MD. Accessed April 20, 2022. https://www.ahrq.gov/workingforquality/priorities-in-action/sps-network.html; 2017.

        • Wu S
        • Tyler A
        • Logsdon T
        • et al.
        A quality improvement collaborative to improve the discharge process for hospitalized children.
        Pediatrics. 2016; 138e20143604https://doi.org/10.1542/peds.2014-3604
        • Gay JC
        • Teufel RJ
        • Peltz A
        • et al.
        Variation in condition-specific readmission rates across US children's hospitals.
        Acad Pediatr. 2022; 22: 797-805https://doi.org/10.1016/j.acap.2022.01.007
        • Gay JC
        • Hall M
        • Morse R
        • et al.
        Observation encounters and length of stay benchmarking in children's hospitals.
        Pediatrics. 2020; 146e20200120https://doi.org/10.1542/peds.2020-0120
        • Fieldston ES
        • Shah SS
        • Hall M
        • et al.
        Resource utilization for observation-status stays at children's hospitals.
        Pediatrics. 2013; 131: 1050-1058https://doi.org/10.1542/peds.2012-2494
        • Synhorst DC
        • Hall M
        • Harris M
        • et al.
        Hospital observation status and readmission rates.
        Pediatrics. 2020; 146e202003954https://doi.org/10.1542/peds.2020-003954
      7. Readmissions. Boston Children's Hospital. Accessed October 20, 2021. http://www.childrenshospital.org/research-and-innovation/research/centers/center-of-excellence-for-pediatric-quality-measurement-cepqm/cepqm-measures/pediatric-readmissions; 2016

      8. Center of Excellence for Pediatric Quality Measurement. Readmissions. Accessed September 20, 2021. www.childrenshospital.org/research-and-innovation/research/centers/center-of-excellence-for-pediatric-quality-measurement-cepqm/cepqm-measures/pediatric-readmissions.

      9. National Quality Forum. Pediatric all-condition readmission measure. Accessed September 20, 2021. www.qualityforum.org/QPS/MeasureDetails.aspx?standardID=2393&print=0&entityTypeID=1.

        • Feudtner C
        • Feinstein JA
        • Zhong W
        • et al.
        Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation.
        BMC Pediatr. 2014; 14: 199https://doi.org/10.1186/1471-2431-14-199
      10. Chronic Condition Indicator (CCI) for ICD-10-CM. Agency for Healthcare Research and Quality. Rockville, MD. Accessed September 20, 2021. https://www.hcup-us.ahrq.gov/toolssoftware/chronic_icd10/chronic_icd10.jsp; 2020.

      11. Disparity Methods Confidential Reporting Hospital-Specific Reports. Centers for Medicare & Medicaid Services. Baltimore, MD. Accessed on December 20, 2021. https://qualitynet.cms.gov/inpatient/measures/disparity-methods/reports; 2021.

      12. Public Reporting User Guide for the Hospital-Specific Reports on Outcome Payment, and CMS Patient Safety Indicator Measures. Centers for Medicare & Medicaid Services. Baltimore, MD; Accessed December 20, 2021. https://qualitynet.cms.gov/files/609165382d69df00226c90cd?filename=Jul2021_PR_Public_Reporting_HUG.pdf; 2021.

        • Statile AM
        • Schondelmeyer AC
        • Thomson JE
        • et al.
        Improving discharge efficiency in medically complex pediatric patients.
        Pediatrics. 2016; 138e20153832https://doi.org/10.1542/peds.2015-3832
        • Shermont H
        • Pignataro S
        • Humphrey K
        • et al.
        Reducing pediatric readmissions: using a discharge bundle combined with teach-back methodology.
        J Nurs Care Qual. 2016; 31: 224-232https://doi.org/10.1097/NCQ.0000000000000176
        • Leathers LA
        • Brittain KL
        • Crowley K
        Effect of a pediatric prescription medication discharge program on reducing hospital readmission rates.
        J Pediatr Pharmacol Ther. 2017; 22: 94-101https://doi.org/10.5863/1551-6776-22.2.94
        • Coller RJ
        • Klitzner TS
        • Saenz AA
        • et al.
        Discharge handoff communication and pediatric readmissions.
        J Hosp Med. 2017; 12: 29-35https://doi.org/10.1002/jhm.2670
        • Johnson RF
        • Chang A
        • Mitchell RB
        Nationwide readmissions after tonsillectomy among pediatric patients - United States.
        Int J Pediatr Otorhinolaryngol. 2018; 107: 10-13https://doi.org/10.1016/j.ijporl.2018.01.026
        • Shay S
        • Shapiro NL
        • Bhattacharyya N
        Revisit rates and diagnoses following pediatric tonsillectomy in a large multistate population.
        Laryngoscope. 2015; 125: 457-461https://doi.org/10.1002/lary.24783
        • Pediatric All-Condition Readmission Measure
        AHRQ Pub. No. 14(16)-P008-3-EF.
        Agency for Healthcare Research and Quality, Rockville, MD2014 (Accessed on April 22, 2022)
        • Press MJ
        • Scanlon DP
        • Ryan AM
        • et al.
        Limits of readmission rates in measuring hospital quality suggest the need for added metrics.
        Health Aff (Millwood). 2013; 32: 1083-1091https://doi.org/10.1377/hlthaff.2012.0518
        • Gonzalez AA
        • Girotti ME
        • Shih T
        • et al.
        Reliability of hospital readmission rates in vascular surgery.
        J Vasc Surg. 2014; 59: 1638-1643https://doi.org/10.1016/j.jvs.2013.12.040
        • Thompson MP
        • Kaplan CM
        • Cao Y
        • et al.
        Reliability of 30-day readmission measures used in the Hospital Readmission Reduction Program.
        Health Serv Res. 2016; 5196: 2095-2114https://doi.org/10.1111/1475-6773.12587
        • Shih T
        • Dimick JB
        Reliability of readmission rates as a hospital quality measure in cardiac surgery.
        Ann Thorac Surg. 2014; 97: 1214-1218https://doi.org/10.1016/j.athoracsur.2013.11.048
        • Sills MR
        • Hall M
        • Colvin JD
        • et al.
        Association of social determinants with children's hospitals’ preventable readmissions performance.
        JAMA Pediatr. 2016; 170: 350-358https://doi.org/10.1001/jamapediatrics.2015.4440
        • Auger KA
        • Ponti-Zins MC
        • Statile AM
        • et al.
        Performance of pediatric readmission measures.
        J Hosp Med. 2020; 15: 723-726https://doi.org/10.12788/jhm.3521
        • Auger KA
        • Teufel RJ
        • Harris JM
        • et al.
        Children's hospital characteristics and readmission metrics.
        Pediatrics. 2017; 139e20161720https://doi.org/10.1542/peds.2016-1720
        • Colvin JD
        • Hall M
        • Gottlieb L
        • et al.
        Hospitalizations of low-income children and children with severe health conditions: implications of the Patient Protection and Affordable Care Act.
        JAMA Pediatr. 2016; 170: 176-178https://doi.org/10.1001/jamapediatrics.2015.3366
        • Opipari VP
        • Daniels SR
        • Wilmott RW
        • Jacobs RF.
        Medicaid and children's hospitals—a vital but strained double helix for children's health care.
        JAMA Pediatr. 2016; 170: 1043-1045https://doi.org/10.1001/jamapediatrics.2016.2328
        • Gay JC
        • Agrawal R
        • Auger KA
        • et al.
        Rates and impact of potentially preventable readmissions at children's hospitals.
        J Pediatr. 2015; 166: 613-619.e5https://doi.org/10.1016/j.jpeds.2014.10.052
        • Auger KA
        • Harris JM
        • Gay JC
        • et al.
        Progress (?) toward reducing pediatric readmissions.
        J Hosp Med. 2019; 14: 618-621https://doi.org/10.12788/jhm.3210