JAMA: Improved care coordination lowers pediatric readmission rates
Nearly 20 percent of admissions and 23.2 percent of inpatient expenditures--$3.4 billion--were devoted to 2.9 percent of patients who were readmitted to the same children's hospital four or more times within a year, according to a study in the Feb. 16 issue of the Journal of the American Medical Association.
Jay G. Berry, MD, MPH, an attending physician in the Complex Care Service at Children's Hospital Boston, John Neff, MD, from Seattle Children's Hospital, and colleagues examined inpatient utilization of children experiencing recurrent hospital readmissions within a 365-day interval following an index admission. The authors evaluated pediatric patients' clinical and demographic characteristics and reasons for readmission.
The retrospective analysis was based on data collected between 2003 and 2008 from the Pediatric Hospital Information System, a database of hospitalization data from 37 freestanding, tertiary care pediatric hospitals.
“An analysis of 317,643 patients found that many of the readmissions experienced by the children readmitted the most frequently might have been avoidable with improved inpatient and outpatient care coordination, care planning and community healthcare support,” the authors wrote.
Among patients with four or more readmissions within the 365-day interval following an initial admission, 28.5 percent were hospitalized repeatedly for a problem in the same organ system. Among the percentage of hospitalizations associated with an ambulatory care-sensitive condition (ACSC), asthma was the most common reason for admission, followed by pneumonia and seizures.
The authors found that neuromuscular complex chronic conditions such as cerebral palsy or brain malformations associated with severe developmental disabilities were the most prevalent disease groups among patients frequently readmitted, and gastrostomy tubes were the most frequent medical technology utilized by these patients. "There may be readmissions among these children that could be considered ambulatory care sensitive but are not included within the current ACSC set," the authors suggested.
As readmission frequency increased from zero to four or more readmissions, increases were seen in:
Even with optimal planning, future readmissions may not be preventable in children with complex chronic health conditions if community providers and the health system are underequipped to meet patients' healthcare needs and minimize chronic illness exacerbations, the authors concluded. “As tertiary care hospitals are driven to lower their costs, and global payment contracts require primary care providers and hospitals to share the cost risk of caring for patients, better integration and communication may be forced on healthcare providers.”
Jay G. Berry, MD, MPH, an attending physician in the Complex Care Service at Children's Hospital Boston, John Neff, MD, from Seattle Children's Hospital, and colleagues examined inpatient utilization of children experiencing recurrent hospital readmissions within a 365-day interval following an index admission. The authors evaluated pediatric patients' clinical and demographic characteristics and reasons for readmission.
The retrospective analysis was based on data collected between 2003 and 2008 from the Pediatric Hospital Information System, a database of hospitalization data from 37 freestanding, tertiary care pediatric hospitals.
“An analysis of 317,643 patients found that many of the readmissions experienced by the children readmitted the most frequently might have been avoidable with improved inpatient and outpatient care coordination, care planning and community healthcare support,” the authors wrote.
Among patients with four or more readmissions within the 365-day interval following an initial admission, 28.5 percent were hospitalized repeatedly for a problem in the same organ system. Among the percentage of hospitalizations associated with an ambulatory care-sensitive condition (ACSC), asthma was the most common reason for admission, followed by pneumonia and seizures.
The authors found that neuromuscular complex chronic conditions such as cerebral palsy or brain malformations associated with severe developmental disabilities were the most prevalent disease groups among patients frequently readmitted, and gastrostomy tubes were the most frequent medical technology utilized by these patients. "There may be readmissions among these children that could be considered ambulatory care sensitive but are not included within the current ACSC set," the authors suggested.
As readmission frequency increased from zero to four or more readmissions, increases were seen in:
- Children ages 13 to 18 years;
- Patients older than 18 years;
- Patients who had public insurance;
- Non-Hispanic black patients;
- Patients with one or more complex chronic conditions; and
- Patients requiring technology assistance.
Even with optimal planning, future readmissions may not be preventable in children with complex chronic health conditions if community providers and the health system are underequipped to meet patients' healthcare needs and minimize chronic illness exacerbations, the authors concluded. “As tertiary care hospitals are driven to lower their costs, and global payment contracts require primary care providers and hospitals to share the cost risk of caring for patients, better integration and communication may be forced on healthcare providers.”