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Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals
Jay G Berry1, David E Hall, Dennis Z Kuo
1Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
Insights
A small group of children with recurrent hospital readmissions accounted for significant healthcare costs and admissions. These patients often had complex chronic conditions and were readmitted for issues within the same organ system.
Area of Science:
- Pediatric Healthcare Research
- Health Services Research
- Quality Improvement in Medicine
Background:
- Early hospital readmission is a key indicator of healthcare quality.
- Limited data exist on rehospitalization patterns and impact for children with chronic illnesses.
Purpose of the Study:
- To characterize inpatient resource use, clinical profiles, and admission causes for children with recurrent hospital readmissions.
- To understand the patterns and impact of recurrent hospitalizations in pediatric populations.
Main Methods:
- Retrospective cohort analysis of over 300,000 patients admitted to 37 US children's hospitals between 2003 and 2008.
- Follow-up data collected through 2008 to track readmission patterns within 365-day intervals.
- Analysis focused on identifying patients with 4 or more readmissions within any 365-day period.
Main Results:
- 2.9% of patients experienced 4 or more readmissions within a 365-day interval, with a median of 37 days between admissions.
- These frequent readmissions constituted 18.8% of all admissions and 23.2% of total inpatient charges ($3.4 billion).
- Patients with frequent readmissions were more likely to have complex chronic conditions (89.0%), require technology assistance (52.6%), have public insurance (56.3%), and be non-Hispanic Black (34.4%).
Conclusions:
- A small proportion of pediatric patients drive a significant portion of hospital admissions and costs due to recurrent readmissions.
- Recurrent hospitalizations are often linked to complex chronic conditions and issues within the same organ system.
- Understanding these patterns is crucial for improving care quality and resource allocation in pediatric healthcare.
Context:
Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact.
Objectives:
To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals.
Design, Setting, And Patients:
Retrospective cohort analysis of 317,643 patients (n = 579,504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008.
Main Outcome Measure:
Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period.
Results:
In the sample, 69,294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21-63). These patients accounted for 18.8% (109,155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n = 55,382/248,349] to 89.0% [n = 8225/9237]; P < .001), technology assistance (from 5.3% [n = 13,163] to 52.6% [n = 4859]; P < .001), public insurance use (from 40.9% [n = 101,575] to 56.3% [n = 5202]; P < .001), and non-Hispanic black race (from 21.8% [n = 54,140] to 34.4% [n = 3181]; P < .001); and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23.1% [62,847/272,065] to 14.0% [15,282/109,155], P < .001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval.
Conclusions:
Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.
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