State-level child health system performance and the likelihood of readmission to children's hospitals

J Pediatr. 2010 Jul;157(1):98-102.e1. doi: 10.1016/j.jpeds.2010.01.049. Epub 2010 Mar 20.


Objectives: To assess the relationship between children's hospital readmission and the performance of child health systems in the states in which hospitals are located.

Study design: We conducted a retrospective cohort study of 197,744 patients 2 to 18 years old from 39 children's hospitals located in 24 states in the United States in 2005. Subjects were observed for a year after discharge for readmission to the same hospital. The odds of readmission were modeled on the basis of patient-level characteristics and state child health system performance as ranked by the Commonwealth Fund.

Results: A total of 1.8% of patients were readmitted within a week, 4.8% within a month, and 16.3% within 365 days. After adjustment for patient-level characteristics, the probability of readmission varied significantly between states (P=.001), and the likelihood of readmission during the ensuing year increased as the states' health system performance ranking improved. States in the best ranking quartile had a 2.03% higher readmission rate than states in the lowest quartile (P=.02); the same directional relationship was observed for readmission intervals from 1 to 365 days after discharge.

Conclusions: Hospital readmission rates are significantly related to the performance of the surrounding health care system.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Hospitalized / statistics & numerical data*
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities / statistics & numerical data*
  • Hospitals / statistics & numerical data
  • Humans
  • Male
  • Patient Readmission / statistics & numerical data*
  • Retrospective Studies
  • United States