CONTEXT: Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact. OBJECTIVES: To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals. DESIGN, SETTING, AND PATIENTS: Retrospective cohort analysis of 317,643 patients (n = 579,504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008. MAIN OUTCOME MEASURE: Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period. RESULTS: In the sample, 69,294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21-63). These patients accounted for 18.8% (109,155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n = 55,382/248,349] to 89.0% [n = 8225/9237]; P < .001), technology assistance (from 5.3% [n = 13,163] to 52.6% [n = 4859]; P < .001), public insurance use (from 40.9% [n = 101,575] to 56.3% [n = 5202]; P < .001), and non-Hispanic black race (from 21.8% [n = 54,140] to 34.4% [n = 3181]; P < .001); and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23.1% [62,847/272,065] to 14.0% [15,282/109,155], P < .001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval. CONCLUSIONS: Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.
CONTEXT: Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact. OBJECTIVES: To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals. DESIGN, SETTING, AND PATIENTS: Retrospective cohort analysis of 317,643 patients (n = 579,504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008. MAIN OUTCOME MEASURE: Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period. RESULTS: In the sample, 69,294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21-63). These patients accounted for 18.8% (109,155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n = 55,382/248,349] to 89.0% [n = 8225/9237]; P < .001), technology assistance (from 5.3% [n = 13,163] to 52.6% [n = 4859]; P < .001), public insurance use (from 40.9% [n = 101,575] to 56.3% [n = 5202]; P < .001), and non-Hispanic black race (from 21.8% [n = 54,140] to 34.4% [n = 3181]; P < .001); and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23.1% [62,847/272,065] to 14.0% [15,282/109,155], P < .001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval. CONCLUSIONS: Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.
Authors: Bryan L Stone; Nancy A Murphy; Michael B Mundorff; Howard B Parker; Paula R Peterson; Rajendu Srivastava Journal: J Pediatr Rehabil Med Date: 2008
Authors: Erin J Aiello Bowles; Leah Tuzzio; Debra P Ritzwoller; Andrew E Williams; Tyler Ross; Edward H Wagner; Christine Neslund-Dudas; Andrea Altschuler; Virginia Quinn; Mark Hornbrook; Larissa Nekhlyudov Journal: Med Care Date: 2009-10 Impact factor: 2.983
Authors: Chris Feudtner; James E Levin; Rajendu Srivastava; Denise M Goodman; Anthony D Slonim; Vidya Sharma; Samir S Shah; Susmita Pati; Crayton Fargason; Matt Hall Journal: Pediatrics Date: 2009-01 Impact factor: 7.124
Authors: Jay G Berry; Kevin Blaine; Jayne Rogers; Sarah McBride; Edward Schor; Jackie Birmingham; Mark A Schuster; Chris Feudtner Journal: JAMA Pediatr Date: 2014-10 Impact factor: 16.193
Authors: Shannon M Hudson; Martina Mueller; William H Hester; Gayenell S Magwood; Susan D Newman; Marilyn A Laken Journal: J Spec Pediatr Nurs Date: 2014-03-03 Impact factor: 1.260
Authors: Tamara D Simon; Mary Lawrence Cawthon; Susan Stanford; Jean Popalisky; Dorothy Lyons; Peter Woodcox; Margaret Hood; Alex Y Chen; Rita Mangione-Smith Journal: Pediatrics Date: 2014-05-12 Impact factor: 7.124
Authors: Jay G Berry; Matt Hall; John Neff; Denise Goodman; Eyal Cohen; Rishi Agrawal; Dennis Kuo; Chris Feudtner Journal: Health Aff (Millwood) Date: 2014-12 Impact factor: 6.301
Authors: JoAnna K Leyenaar; Emily R O'Brien; Laurel K Leslie; Peter K Lindenauer; Rita M Mangione-Smith Journal: Pediatrics Date: 2016-12-02 Impact factor: 7.124