Mari M Nakamura1,2,3, Alan M Zaslavsky4, Sara L Toomey5,3, Carter R Petty6, Maria C Bryant5, Alexandra T Geanacopoulos5, Ashish K Jha7,8,9, Mark A Schuster5,3. 1. Divisions of General Pediatrics and mari.nakamura@childrens.harvard.edu. 2. Infectious Diseases, and. 3. Departments of Pediatrics and. 4. Health Care Policy, Harvard Medical School, and. 5. Divisions of General Pediatrics and. 6. Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts. 7. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts. 8. Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and. 9. Veterans Affairs Boston Healthcare System, Boston, Massachusetts.
Abstract
BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmission, and readmission diagnoses. METHODS: We analyzed 2008-2009 Medicaid Analytic eXtract data for patients <18 years of age in 26 states. We identified LRI hospitalizations based on a primary diagnosis of bronchiolitis, influenza, or community-acquired pneumonia or a secondary diagnosis of one of these LRIs plus a primary diagnosis of asthma, respiratory failure, or sepsis/bacteremia. Readmission rates were calculated as the proportion of hospitalizations followed by ≥1 unplanned readmission within 30 days. We used logistic regression with fixed effects for patient characteristics and a hospital random intercept to case-mix adjust rates and assess risk factors. RESULTS: Of 150 590 LRI hospitalizations, 8233 (5.5%) were followed by ≥1 readmission. The median adjusted hospital readmission rate was 5.2% (interquartile range: 5.1%-5.4%), and rates varied across hospitals (P < .0001). Infants (patients <1 year of age), boys, and children with chronic conditions were more likely to be readmitted. The most common primary diagnoses on readmission were LRIs (48.2%), asthma (10.0%), fluid/electrolyte disorders (3.4%), respiratory failure (3.3%), and upper respiratory infections (2.7%). CONCLUSIONS: LRI readmissions are common and vary across hospitals. Multiple risk factors are associated with readmission, indicating potential targets for strategies to reduce readmissions. Readmission diagnoses sometimes seem related to the original LRI.
BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are among the most common reasons for pediatric hospitalization and among the diagnoses with the highest number of readmissions. Characterizing LRI readmissions would help guide efforts to prevent them. We assessed variation in pediatric LRI readmission rates, risk factors for readmission, and readmission diagnoses. METHODS: We analyzed 2008-2009 Medicaid Analytic eXtract data for patients <18 years of age in 26 states. We identified LRI hospitalizations based on a primary diagnosis of bronchiolitis, influenza, or community-acquired pneumonia or a secondary diagnosis of one of these LRIs plus a primary diagnosis of asthma, respiratory failure, or sepsis/bacteremia. Readmission rates were calculated as the proportion of hospitalizations followed by ≥1 unplanned readmission within 30 days. We used logistic regression with fixed effects for patient characteristics and a hospital random intercept to case-mix adjust rates and assess risk factors. RESULTS: Of 150 590 LRI hospitalizations, 8233 (5.5%) were followed by ≥1 readmission. The median adjusted hospital readmission rate was 5.2% (interquartile range: 5.1%-5.4%), and rates varied across hospitals (P < .0001). Infants (patients <1 year of age), boys, and children with chronic conditions were more likely to be readmitted. The most common primary diagnoses on readmission were LRIs (48.2%), asthma (10.0%), fluid/electrolyte disorders (3.4%), respiratory failure (3.3%), and upper respiratory infections (2.7%). CONCLUSIONS: LRI readmissions are common and vary across hospitals. Multiple risk factors are associated with readmission, indicating potential targets for strategies to reduce readmissions. Readmission diagnoses sometimes seem related to the original LRI.
Authors: Bram P Raphael; Maria Jorina; Mary Gallotto; Glendalis Grullon; Meghan Dalton; Melissa Takvorian-Bené; Christina Tascione; Carolyn Rosa; Jennifer McClelland; Megan Gray; Alexis K Potemkin; Courtney Glavin; Kathleen M Gura; Margaret K Murphy; Kierrah Leger; Judith Mahoney; Jessica Kerr; Al Ozonoff; Christopher P Duggan Journal: JPEN J Parenter Enteral Nutr Date: 2018-03-30 Impact factor: 4.016
Authors: Diana M Bowser; Katharine R Rowlands; Dhwani Hariharan; Raíssa M Gervasio; Lauren Buckley; Yara Halasa-Rappel; Elizabeth L Glaser; Christopher B Nelson; Donald S Shepard Journal: J Infect Dis Date: 2022-08-15 Impact factor: 7.759