Ryan O'Connell1,2,3, William Feaster1,2, Vera Wang1,4, Sharief Taraman1,2,5, Louis Ehwerhemuepha6,7,8. 1. Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC, Orange, California, USA. 2. Children's Hospital of Orange County (CHOC), Orange, California, USA. 3. Department of Emergency Medicine, University of California - Irvine, Irvine, California, USA. 4. Neuroscience, Hamilton College, Clinton, New York, USA. 5. Department of Pediatrics, University of California - Irvine, Irvine, California, USA. 6. Sharon Disney Lund Medical Intelligence and Innovation Institute (MI3) at CHOC, Orange, California, USA. lehwerhemuepha@choc.org. 7. Children's Hospital of Orange County (CHOC), Orange, California, USA. lehwerhemuepha@choc.org. 8. Chapman University School of Computational and Data Science, Orange, California, USA. lehwerhemuepha@choc.org.
Abstract
BACKGROUND: Unplanned readmission is one of many measures of the quality of care of pediatric patients with neurological conditions. In this multicenter study, we searched for novel risk factors of readmission of patients with neurological conditions. METHODS: We retrieved hospitalization data of patients less than 18 years with one or more neurological conditions. This resulted in a total of 105,834 encounters from 18 hospitals. We included data on patient demographics, prior healthcare resource utilization, neurological conditions, number of other conditions/diagnoses, number of medications, and number of surgical procedures performed. We developed a random intercept logistic regression model using stepwise minimization of Akaike Information Criteria for variable selection. RESULTS: The most important neurological conditions associated with unplanned pediatric readmissions include hydrocephalus, inflammatory diseases of the central nervous system, sleep disorders, disease of myoneural junction and muscle, other central nervous system disorder, other spinal cord conditions (such as vascular myelopathies, and cord compression), and nerve, nerve root and plexus disorders. Current and prior healthcare resource utilization variables, number of medications, other diagnoses, and certain inpatient surgical procedures were associated with changes in odds of readmission. The area under the receiver operator characteristic curve (AUROC) on the independent test set is 0.733 (0.722, 0.743). CONCLUSIONS: Pediatric patients with certain neurological conditions are more likely to be readmitted than others. However, current and prior healthcare resource utilization remain some of the strongest indicators of readmission within this population as in the general pediatric population.
BACKGROUND: Unplanned readmission is one of many measures of the quality of care of pediatric patients with neurological conditions. In this multicenter study, we searched for novel risk factors of readmission of patients with neurological conditions. METHODS: We retrieved hospitalization data of patients less than 18 years with one or more neurological conditions. This resulted in a total of 105,834 encounters from 18 hospitals. We included data on patient demographics, prior healthcare resource utilization, neurological conditions, number of other conditions/diagnoses, number of medications, and number of surgical procedures performed. We developed a random intercept logistic regression model using stepwise minimization of Akaike Information Criteria for variable selection. RESULTS: The most important neurological conditions associated with unplanned pediatric readmissions include hydrocephalus, inflammatory diseases of the central nervous system, sleep disorders, disease of myoneural junction and muscle, other central nervous system disorder, other spinal cord conditions (such as vascular myelopathies, and cord compression), and nerve, nerve root and plexus disorders. Current and prior healthcare resource utilization variables, number of medications, other diagnoses, and certain inpatient surgical procedures were associated with changes in odds of readmission. The area under the receiver operator characteristic curve (AUROC) on the independent test set is 0.733 (0.722, 0.743). CONCLUSIONS: Pediatric patients with certain neurological conditions are more likely to be readmitted than others. However, current and prior healthcare resource utilization remain some of the strongest indicators of readmission within this population as in the general pediatric population.
Authors: Elan L Guterman; Vanja C Douglas; Maulik P Shah; Tennille Parsons; Julio Barba; S Andrew Josephson Journal: Neurology Date: 2016-01-20 Impact factor: 9.910
Authors: Louis Ehwerhemuepha; Karen Pugh; Alex Grant; Sharief Taraman; Anthony Chang; Cyril Rakovski; William Feaster Journal: Hosp Pediatr Date: 2019-12-06
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: Louis Ehwerhemuepha; Gary Gasperino; Nathaniel Bischoff; Sharief Taraman; Anthony Chang; William Feaster Journal: BMC Med Inform Decis Mak Date: 2020-06-19 Impact factor: 2.796