Jessica L Markham1, Matt Hall2,3, James C Gay4, Jessica L Bettenhausen2, Jay G Berry5. 1. Division of Pediatric Hospital Medicine, Children's Mercy Kansas City and Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; jlmarkham@cmh.edu. 2. Division of Pediatric Hospital Medicine, Children's Mercy Kansas City and Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri. 3. Children's Hospital Association, Lenexa, Kansas. 4. Division of General Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt and Department of Pediatrics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee; and. 5. Complex Care Service, Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND AND OBJECTIVES: Readmissions burden the health care system. Despite increasing attention to readmission rates, little is known about the duration and cost of readmissions. The objective of this study was to assess, nationally, the length of stay (LOS) and costs for 30-day readmissions in children. METHODS: We performed a retrospective analysis of 30-day readmissions by using the 2013 Nationwide Readmissions Database. We used generalized linear mixed effects models adjusted for important clinical and demographic factors to assess LOS and cost for index admissions, readmissions, and the episode of care (index admission plus readmission). RESULTS: A total of 125 183 (4.5%) children had a 30-day readmission; 87.1% of readmissions were to the same hospital. Readmitted children had an adjusted episode LOS that was 2 times longer (5.8 vs 2.9 days) and total costs that were 2.3 times higher ($12 250 vs $5340) than those who were not readmitted. Associations of readmissions with episode LOS and costs varied significantly by condition (P < .001). Children readmitted to a different versus the same hospital had an episode LOS that was the same (5.8 days; P = .279) but higher episode of care costs ($15 876 vs $11 661; P < .001). CONCLUSIONS: Readmitted children spend twice as many days in the hospital compared with children who are not readmitted and have higher hospital costs, especially when readmitted to a different hospital. In addition to readmission rate, readmission metrics may benefit from measurement of total LOS and costs for both the index admission and its associated readmission.
BACKGROUND AND OBJECTIVES: Readmissions burden the health care system. Despite increasing attention to readmission rates, little is known about the duration and cost of readmissions. The objective of this study was to assess, nationally, the length of stay (LOS) and costs for 30-day readmissions in children. METHODS: We performed a retrospective analysis of 30-day readmissions by using the 2013 Nationwide Readmissions Database. We used generalized linear mixed effects models adjusted for important clinical and demographic factors to assess LOS and cost for index admissions, readmissions, and the episode of care (index admission plus readmission). RESULTS: A total of 125 183 (4.5%) children had a 30-day readmission; 87.1% of readmissions were to the same hospital. Readmitted children had an adjusted episode LOS that was 2 times longer (5.8 vs 2.9 days) and total costs that were 2.3 times higher ($12 250 vs $5340) than those who were not readmitted. Associations of readmissions with episode LOS and costs varied significantly by condition (P < .001). Children readmitted to a different versus the same hospital had an episode LOS that was the same (5.8 days; P = .279) but higher episode of care costs ($15 876 vs $11 661; P < .001). CONCLUSIONS: Readmitted children spend twice as many days in the hospital compared with children who are not readmitted and have higher hospital costs, especially when readmitted to a different hospital. In addition to readmission rate, readmission metrics may benefit from measurement of total LOS and costs for both the index admission and its associated readmission.
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Authors: Devin M Parker; Allen D Everett; Meagan E Stabler; Marshall L Jacobs; Jeffrey P Jacobs; Luca Vricella; Heather Thiessen-Philbrook; Chirag R Parikh; Cedric Manlhiot; Jeremiah R Brown Journal: Ann Thorac Surg Date: 2020-04-01 Impact factor: 4.330
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