Kavita Parikh1, Matt Hall2, Chén C Kenyon3, Ronald J Teufel4, Grant M Mussman5, Amanda Montalbano6, Jessica Gold7, James W Antoon8, Anupama Subramony9, Vineeta Mittal10, Rustin B Morse10, Karen M Wilson11, Samir S Shah12. 1. Children's National Medical Center and George Washington School of Medicine, Washington, DC. Electronic address: kparikh@childrensnational.org. 2. Children's Hospital Association, Lenexa, KS. 3. The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, PA. 4. Medical University of South Carolina, Charleston, SC. 5. Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. 6. Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, MO. 7. Lucile Packard Children's Hospital Stanford and Stanford University School of Medicine, Stanford, CA. 8. Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, IL. 9. Cohen Children's Medical Center, Northwell Health, Hofstra School of Medicine, New Hyde Park, NY. 10. Children's Health, Children's Medical Center, Dallas, TX. 11. Icahn School of Medicine at Mount Sinai, New York, NY. 12. Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
Abstract
OBJECTIVES: To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. STUDY DESIGN: This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated. RESULTS: The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation. CONCLUSIONS: Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.
OBJECTIVES: To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates. STUDY DESIGN: This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated. RESULTS: The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation. CONCLUSIONS: Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.
Authors: Chén C Kenyon; David M Rubin; Joseph J Zorc; Zeinab Mohamad; Jennifer A Faerber; Chris Feudtner Journal: J Pediatr Date: 2015-01-29 Impact factor: 4.406
Authors: Sanjit K Bhogal; David McGillivray; Jean Bourbeau; Andrea Benedetti; Susan Bartlett; Francine M Ducharme Journal: Ann Emerg Med Date: 2012-03-10 Impact factor: 5.721
Authors: Chén C Kenyon; Patrice R Melvin; Vincent W Chiang; Marc N Elliott; Mark A Schuster; Jay G Berry Journal: J Pediatr Date: 2013-11-14 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: Alisa Khan; Mari M Nakamura; Alan M Zaslavsky; Jisun Jang; Jay G Berry; Jeremy Y Feng; Mark A Schuster Journal: JAMA Pediatr Date: 2015-10 Impact factor: 16.193