Mark I Neuman1, Matthew Hall2, James C Gay3, Anne J Blaschke4, Derek J Williams5, Kavita Parikh6, Adam L Hersh7, Thomas V Brogan8, Jeffrey S Gerber9, Carlos G Grijalva10, Samir S Shah11. 1. Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts;Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; mark.neuman@childrens.harvard.edu. 2. The Children's Hospital Association, Overland Park, Kansas; 3. Divisions of General Pediatrics, and. 4. Division of Infectious Diseases, Primary Children's Medical Center, Salt Lake City, Utah;Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; 5. Departments of Pediatrics, andHospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; 6. Division of Hospital Medicine, Children's National Medical Center, Washington, District of Columbia;Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia; 7. Division of Infectious Diseases, Primary Children's Medical Center, Salt Lake City, Utah;Departments of Pediatrics, and. 8. Division of Critical Care, Seattle Children's Hospital, Seattle, Washington;Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; 9. Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; 10. Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee; 11. Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; andDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Abstract
BACKGROUND AND OBJECTIVES: Pneumonia is a leading cause of hospitalization and readmission in children. Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs. The objective of this study was to characterize readmission rates, and identify factors and costs associated with readmission among children previously hospitalized with pneumonia. METHODS: Retrospective cohort study of children hospitalized with pneumonia at the 43 hospitals included in the Pediatric Health Information System between January 1, 2008, and December 31, 2011. The primary outcome was all-cause readmission within 30 days after hospital discharge, and the secondary outcome was pneumonia-specific readmission. We used multivariable regression models to identify patient and hospital characteristics and costs associated with readmission. RESULTS: A total of 82 566 children were hospitalized with pneumonia (median age, 3 years; interquartile range 1-7). Thirty-day all-cause and pneumonia-specific readmission rates were 7.7% and 3.1%, respectively. Readmission rates were higher among children <1 year of age, as well as in patients with previous hospitalizations, longer index hospitalizations, and complicated pneumonia. Children with chronic medical conditions were more likely to experience all-cause (odds ratio 3.0; 95% confidence interval 2.8-3.2) and pneumonia-specific readmission (odds ratio 1.8; 95% confidence interval 1.7-2.0) compared with children without chronic medical conditions. The median cost of a readmission ($11 344) was higher than that of an index admission ($4495; P = .01). Readmissions occurred in 8% of pneumonia hospitalizations but accounted for 16.3% of total costs for all pneumonia hospitalizations. CONCLUSIONS: Readmissions are common after hospitalization for pneumonia, especially among young children and those with chronic medical conditions, and are associated with substantial costs.
BACKGROUND AND OBJECTIVES:Pneumonia is a leading cause of hospitalization and readmission in children. Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs. The objective of this study was to characterize readmission rates, and identify factors and costs associated with readmission among children previously hospitalized with pneumonia. METHODS: Retrospective cohort study of children hospitalized with pneumonia at the 43 hospitals included in the Pediatric Health Information System between January 1, 2008, and December 31, 2011. The primary outcome was all-cause readmission within 30 days after hospital discharge, and the secondary outcome was pneumonia-specific readmission. We used multivariable regression models to identify patient and hospital characteristics and costs associated with readmission. RESULTS: A total of 82 566 children were hospitalized with pneumonia (median age, 3 years; interquartile range 1-7). Thirty-day all-cause and pneumonia-specific readmission rates were 7.7% and 3.1%, respectively. Readmission rates were higher among children <1 year of age, as well as in patients with previous hospitalizations, longer index hospitalizations, and complicated pneumonia. Children with chronic medical conditions were more likely to experience all-cause (odds ratio 3.0; 95% confidence interval 2.8-3.2) and pneumonia-specific readmission (odds ratio 1.8; 95% confidence interval 1.7-2.0) compared with children without chronic medical conditions. The median cost of a readmission ($11 344) was higher than that of an index admission ($4495; P = .01). Readmissions occurred in 8% of pneumonia hospitalizations but accounted for 16.3% of total costs for all pneumonia hospitalizations. CONCLUSIONS: Readmissions are common after hospitalization for pneumonia, especially among young children and those with chronic medical conditions, and are associated with substantial costs.
Authors: Paul D Hain; James C Gay; Tyler W Berutti; Gina M Whitney; Wenli Wang; Benjamin R Saville Journal: Pediatrics Date: 2012-12-10 Impact factor: 7.124
Authors: Thomas V Brogan; Matthew Hall; Derek J Williams; Mark I Neuman; Carlos G Grijalva; Reid W D Farris; Samir S Shah Journal: Pediatr Infect Dis J Date: 2012-10 Impact factor: 2.129
Authors: Andrew F Shorr; Marya D Zilberberg; Richard Reichley; Jason Kan; Alex Hoban; Justin Hoffman; Scott T Micek; Marin H Kollef Journal: Clin Infect Dis Date: 2013-05-15 Impact factor: 9.079
Authors: Anupam B Kharbanda; Matthew Hall; Samir S Shah; Stephen B Freedman; Rakesh D Mistry; Charles G Macias; Bema Bonsu; Peter S Dayan; Evaline A Alessandrini; Mark I Neuman Journal: J Pediatr Date: 2013-01-16 Impact factor: 4.406
Authors: Jay G Berry; Sara L Toomey; Alan M Zaslavsky; Ashish K Jha; Mari M Nakamura; David J Klein; Jeremy Y Feng; Shanna Shulman; Vincent W Chiang; Vincent K Chiang; William Kaplan; Matt Hall; Mark A Schuster Journal: JAMA Date: 2013-01-23 Impact factor: 56.272
Authors: Derek J Williams; Samir S Shah; Angela Myers; Matthew Hall; Katherine Auger; Mary Ann Queen; Karen E Jerardi; Lauren McClain; Catherine Wiggleton; Joel S Tieder Journal: JAMA Pediatr Date: 2013-09 Impact factor: 16.193
Authors: Jean L Raphael; Troy Richardson; Matt Hall; Suzette O Oyeku; David G Bundy; Ram V Kalpatthi; Samir S Shah; Angela M Ellison Journal: J Pediatr Date: 2015-10-23 Impact factor: 4.406
Authors: Mark I Neuman; Matthew Hall; Susan C Lipsett; Adam L Hersh; Derek J Williams; Jeffrey S Gerber; Thomas V Brogan; Anne J Blaschke; Carlos G Grijalva; Kavita Parikh; Lilliam Ambroggio; Samir S Shah Journal: Pediatrics Date: 2017-08-23 Impact factor: 7.124
Authors: Päivi H Salonen; Juha H Salonen; Hanna Säilä; Mika Helminen; Miika Linna; Markku J Kauppi Journal: Clin Rheumatol Date: 2019-11-16 Impact factor: 2.980
Authors: Joanna Thomson; Matt Hall; Jay G Berry; Bryan Stone; Lilliam Ambroggio; Rajendu Srivastava; Samir S Shah Journal: J Pediatr Date: 2016-08-22 Impact factor: 4.406
Authors: Derek J Williams; Yuwei Zhu; Carlos G Grijalva; Wesley H Self; Frank E Harrell; Carrie Reed; Chris Stockmann; Sandra R Arnold; Krow K Ampofo; Evan J Anderson; Anna M Bramley; Richard G Wunderink; Jonathan A McCullers; Andrew T Pavia; Seema Jain; Kathryn M Edwards Journal: Pediatrics Date: 2016-10 Impact factor: 7.124
Authors: Jessica L Markham; Matt Hall; Jennifer L Goldman; Jessica L Bettenhausen; James C Gay; James Feinstein; Julia Simmons; Stephanie K Doupnik; Jay G Berry Journal: J Hosp Med Date: 2021-03 Impact factor: 2.960