Pediatric 30-Day Readmission Rates and Variability across Hospitals

One measure of quality of hospital care patients receive during inpatient treatment used by clinicians, hospitals, patients, health systems, and purchasers of healthcare is the rate of readmission within 30 days of discharge. Because the Centers for Medicare & Medicaid Services are mandated by the Patient Protection and Affordable Care Act to reduce Medicare payments to hospitals with excessively high readmission rates, there has been substantial research on the subject of readmissions for adults; however, readmissions of children have received less attention.

According to researchers, there has been a recent increase in interest in pediatric readmissions. The Children’s Health Insurance Program Reauthorization Act has established the Pediatric Quality Measures Program. The program has identified pediatric readmissions as one of the first measures it will develop. Likewise, the federal Partnership for Patients initiative has issued a challenge to hospitals to reduce pediatric readmission by 20%.

The researchers recently conducted an analysis to determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. They reported results of the analysis in JAMA [2013;309(4):372-380].

The retrospective analysis was conducted utilizing the National Association of Children’s Hospitals and Related Institutions Case Mix Comparative Database of patients ≤18 years of age who were discharged between July 1, 2009, and June 30, 2012, from 72 acute care children’s hospitals in 34 states. Index admissions for labor and delivery, newborns with a routine birth, and chemotherapy, as well as patients who left against medical advice, were transferred to another acute care hospital, or died were excluded from the analysis.

Hospitals with adjusted readmission rates that were 1 standard deviation above and below the mean were defined as having high and low rates, respectively.

The primary outcome measures were 30-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.

The analysis of 568,845 index admissions identified 36,734 (6.5%) readmissions within 30 days of index discharge. Among the children who were readmitted, 14,325 (39.0%) were readmitted in the first 7 days and 22,628 (61.6%) were readmitted in the first 14 days following index discharge.

Readmission rates were higher for children 13 to 18 years of age (7.6%) compared with children 5 to 12 years of age (6.1%), 1 to 4 years of age (6.2%), and <1 year of age (6.2%) (P<.001). Readmission rates increased as the chronic condition indicator (CCI) count increased: 5.4% for 1 CCI, 9.4% for 2 CCIs, 12.4% for 3 CCIs, and 16.8% for ≥4 CCIs. Patient age, CCI group, and CCI count remained significantly associated with the likelihood of readmission in multivariable analysis (P<.001 for all).

Unadjusted readmission rates varied significantly across hospitals (P<.001). Significant variation was observed when measuring all-cause readmissions and when measuring readmissions for the same diagnosis as the index admission (P<.001 for each).

Adjusted rates were 28.6% greater in hospitals with high versus low readmission rates (7.2% [95% confidence interval (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 versus low readmission rates.

“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,” the researchers said.