Katherine A Auger1, Emily L Mueller2, Steven H Weinberg3, Catherine S Forster4, Anita Shah4, Christine Wolski4, Grant Mussman4, Anna J Ipsaro4, Matthew M Davis5. 1. Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: katherine.auger@cchmc.org. 2. Center for Pediatric and Adolescent Comparative Effectiveness Research, and Section of Hematology/Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN. 3. University of Michigan Medical School, Ann Arbor, MI. 4. Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5. Department of Pediatrics, Department of Internal Medicine, University of Michigan Health System, University of Michigan, Ann Arbor, MI; Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Abstract
OBJECTIVE: To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. STUDY DESIGN: We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. RESULTS: Among 166,994 discharges (hospital A: n = 55,383; hospital B: n = 111,611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of "unplanned" was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of "planned" was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. CONCLUSIONS: Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of "unplanned," are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions.
OBJECTIVE: To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children. STUDY DESIGN: We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions. RESULTS: Among 166,994 discharges (hospital A: n = 55,383; hospital B: n = 111,611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of "unplanned" was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of "planned" was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions. CONCLUSIONS: Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of "unplanned," are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions.
Authors: Anita N Shah; Katherine A Auger; Heidi J Sucharew; Colleen Mangeot; Kelsey Childress; Julianne Haney; Samir S Shah; Jeffrey M Simmons; Andrew F Beck Journal: J Hosp Med Date: 2020-11 Impact factor: 2.960
Authors: Katherine A Auger; Samir S Shah; Heather L Tubbs-Cooley; Heidi J Sucharew; Jennifer M Gold; Susan Wade-Murphy; Angela M Statile; Kathleen D Bell; Jane C Khoury; Colleen Mangeot; Jeffrey M Simmons Journal: JAMA Pediatr Date: 2018-09-04 Impact factor: 16.193
Authors: Katherine A Auger; Samir S Shah; Bin Huang; Patrick W Brady; Steven H Weinberg; Elyse Reamer; Kevin S Tanager; Katelin Zahn; Matthew M Davis Journal: J Hosp Med Date: 2019-08 Impact factor: 2.960
Authors: Katherine A Auger; Michael C Ponti-Zins; Angela M Statile; Kris Wesselkamper; Beth Haberman; Samuel P Hanke Journal: J Hosp Med Date: 2020-12 Impact factor: 2.899
Authors: Hadley Sauers-Ford; Angela M Statile; Katherine A Auger; Susan Wade-Murphy; Jennifer M Gold; Jeffrey M Simmons; Samir S Shah Journal: Med Care Date: 2021-08-01 Impact factor: 2.983
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