Pediatric readmission prevalence and variability across hospitals

Abstract

Importance: Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge.

Objective: To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals.

Design, setting, and patients: We analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and Chronic Condition Indicators. Hospitals with adjusted readmission rates that were 1 SD above and below the mean were defined as having "high" and "low" rates, respectively.

Main outcome measures: Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.

Results: The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36,734). Adjusted rates were 28.6% greater in hospitals with high vs low readmission rates (7.2% [95% CI, 7.1%-7.2%] vs 5.6% [95% CI, 5.6%-5.6%]). For the 10 admission diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs low readmission rates. For example, sickle cell rates were 20.1% (95% CI, 20.0%-20.3%) vs 12.7% (95% CI, 12.6%-12.8%) in high vs low hospitals, respectively.

Conclusions and relevance: Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.

Figure 1. Adjusted 30-Day All-Cause Readmission Rate Variation Across 72 Children's Hospitals

The mean unadjusted readmission rate across all hospitals is shown by the dark grey horizontal line. The adjusted rates with 95% confidence intervals are shown for each hospital. The rates were adjusted for age and chronic condition indicators.

Figure 2. Unplanned 30-Day Readmission Rate Variation Across Hospitals, Adjusted for Age and Chronic Condition Indicators

The solid line through the middle of the box represents the mean rate; dashed lines are ±1 SD of the mean; the top and bottom edges of the box are ±2 SD. The whiskers are the minimum and maximum rate.