Pediatric Readmission Prevalence and Variability Across Hospitals

被引：323

作者：

Berry, Jay G. ^{[1
,5
]}

Toomey, Sara L. ^{[5
]}

Zaslavsky, Alan M. ^{[4
]}

Jha, Ashish K. ^{[6
]}

Nakamura, Mari M. ^{[2
,5
]}

Klein, David J.

Feng, Jeremy Y.

Shulman, Shanna

Chiang, Vincent K. ^{[3
,5
]}

Kaplan, William

Hall, Matt ^{[7
]}

Schuster, Mark A. ^{[5
]}

机构：

[1] Harvard Univ, Sch Med, Boston Childrens Hosp, Div Gen Pediat, Boston, MA 02115 USA

[2] Boston Childrens Hosp, Div Infect Dis, Boston, MA USA

[3] Boston Childrens Hosp, Div Emergency Med, Boston, MA USA

[4] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA

[5] Harvard Univ, Sch Med, Dept Pediat, Boston, MA 02115 USA

[6] Harvard Univ, Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA 02115 USA

[7] Childrens Hosp Assoc, Overland Pk, KS USA

来源：

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2013年 / 309卷 / 04期

基金：

美国医疗保健研究与质量局;

关键词：

HEALTH-CARE; CHILDRENS HOSPITALS; SOCIOECONOMIC-STATUS; QUALITY MEASURES; HEART-FAILURE; INSURANCE; OUTCOMES; PROGRAM; INITIATIVES; PERFORMANCE;

D O I：

10.1001/jama.2012.188351

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

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. JAMA. 2013;309(4):372-380 www.jama.com

引用

页码：372 / 380

页数：9

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