Striking differences in 30-day readmission rates may inform prevention efforts
Jan. 22, 2013
Boston, Mass.—Unintended hospital readmissions have become a key quality-of-care indicator, prompting penalties to adult hospitals with a high rate of patient readmissions within 30 days. Using national data, a study led by Boston Children’s Hospital looked at readmission rates at dedicated pediatric hospitals and found great variability. Findings appear in the January 23/30 issue of JAMA, accompanied by an editorial.
The researchers believe there may be several reasons for the varied readmission rates, including differences in hospital care, follow-up care outside of the hospital, and community and family factors that may influence child health.
“Some hospitals and their local health systems had very low readmission rates for diseases that, on average, tend to have much higher rates,” says first author Jay Berry, MD, MPH, a pediatrician in the Complex Care Serviceat Boston Children’s Hospital. “We want to know whether there is something these hospitals and systems are doing to more effectively transition their children home.”
Berry, senior investigator Mark Schuster, MD, PhD, Chief of General Pediatrics at Boston Children’s Hospital, and their colleagues analyzed 568,845 admissions to 72 large tertiary-care children’s hospitals from July 2009 through June 2010. They used data from the National Association of Children’s Hospitals and Related Institutions (NACHRI) Case Mix, adjusting hospitals’ readmission rates for chronic conditions that increase the risk of re-hospitalization. (NACHRI is part of what’s now called the Children’s Hospital Association.)
Overall, 6.5 percent of children had apparently unplanned readmissions to the hospital within 30 days of discharge, and of these, 39 percent were readmitted within 7 days. (By contrast, reported readmission rates at adult hospitals range from 20 to 25 percent.) Two-thirds of readmissions were in children with at least one chronic condition; for certain medical conditions, readmission rates were as high as 23 percent.
The 30-day readmission rates varied among the 72 hospitals, ranging from 4.6 to 8.5 percent. Other findings:
- Readmission rates were 6.9 percent for patients with public insurance (e.g., Medicaid), 5.9 percent for those with private insurance and 4.5 percent for those with no insurance.
- Rates ranged from 5.4 percent for children with one chronic condition to 17 percent for those with four or more.
- Ten conditions accounted for the highest readmission rates: anemia/neutropenia, ventricular shunt procedures, sickle-cell crisis, seizures, gastroenteritis, upper respiratory infection, pneumonia, appendectomy, bronchiolitis and asthma.
- Children with the above 10 conditions accounted for 28 percent of all readmissions. Their readmission rates were 17 to 66 percent higher in hospitals with higher-than-average readmission rates than in low-readmission hospitals.
- Readmission rates were higher for patients with longer hospital stays, from 4.6 percent for patients with a 1- to 2-day stay to 11.2 percent for patients with stays of 7 days or longer.
“Some readmissions cannot be prevented, but various efforts to reduce readmissions by providing better supports for families have been successful at bringing rates lower,” notes Schuster. “The variation we found in readmission rates at different hospitals suggests that there is room to improve. The effort, though, will involve more than just hospitals. Community clinicians and organizations have a role to play as well. Parents also need support in being able to stay home with their recuperating children.”
“Let’s put the child and family first,” says Berry. “There are some children with complicated medical needs who have really high readmission rates. Let’s figure out what’s going on and see if there is an opportunity to make their care transitions better.”
The study was funded by the Agency for Healthcare Research and Quality, the Centers for Medicare and Medicaid Services, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Boston Children’s Hospital
Boston Children’s Hospital is home to the world’s largest research enterprise based at a pediatric medical center, where its discoveries have benefited both children and adults since 1869. More than 1,100 scientists, including nine members of the National Academy of Sciences, 11 members of the Institute of Medicine and 12 members of the Howard Hughes Medical Institute comprise Boston Children’s research community. Founded as a 20-bed hospital for children, Boston Children’s today is a 395-bed comprehensive center for pediatric and adolescent health care grounded in the values of excellence in patient care and sensitivity to the complex needs and diversity of children and families. Boston Children’s also is a teaching affiliate of Harvard Medical School. For more information about research and clinical innovation at Boston Children’s, visit: http://vectorblog.org/.