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Predictors of 30-day readmission and association with primary care follow-up plans
Ryan J Coller1, Thomas S Klitzner, Carlos F Lerner
1Department of Pediatrics, David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA.
Insights
Documentation of primary care follow-up plans in discharge summaries was unexpectedly associated with increased 30-day readmissions in pediatric patients. Further research is needed to understand this complex relationship and improve care transitions.
Area of Science:
- Pediatric Healthcare Quality
- Health Services Research
- Patient Safety
Background:
- Hospital readmissions are a critical measure of healthcare quality.
- Effective inpatient-to-outpatient transitions are essential for preventing readmissions.
- The role of documented primary care provider (PCP) follow-up plans in discharge summaries remains unclear.
Purpose of the Study:
- To investigate the association between the documentation of primary care follow-up plans in discharge summaries and 30-day readmission rates in pediatric patients.
- To identify factors associated with 30-day readmissions in this population.
Main Methods:
- Retrospective cohort study of pediatric patients discharged from a children's hospital (July 2008-July 2010).
- Data analysis included bivariate and propensity-weighted multivariate logistic regressions.
- Key variables examined were patient demographics, illness severity, and PCP follow-up plan documentation.
Main Results:
- The study included 7794 index discharges, with a 30-day readmission rate of 18.7%.
- Factors associated with higher readmission included older age (15-18 years), public insurance, and higher illness severity.
- Surprisingly, documenting PCP follow-up plans was associated with a significantly increased odds of 30-day readmission (OR 4.52).
Conclusions:
- Documenting primary care follow-up plans in discharge summaries may be linked to higher, not lower, 30-day readmission rates.
- Readmission rates are complex and influenced by multiple factors.
- Further research is required to elucidate the inpatient-outpatient transition process and its impact on readmissions.
Objective:
To test the hypothesis that missing primary care follow-up plans in the discharge summary is associated with higher 30-day readmissions.
Study Design:
This retrospective cohort study included pediatric patients discharged from Mattel Children's Hospital, University of California, Los Angeles between July 2008 and July 2010. Exclusions included deaths, transfers, neonatal discharges, stays under 24 hours, and patients over 18 years of age. Bivariate and propensity weighted multivariate logistic regressions tested relationships between 30-day readmission and patient demographics, illness severity, and documentation of primary care provider (PCP) follow-up plans at discharge.
Results:
There were 7794 index discharges (representing 5056 unique patients), with 1457 readmissions within 30 days (18.7%). Average length of stay was 6.3 days. Being 15-18 years old, (OR 1.42 [1.02-1.96]), having public insurance (OR 1.48 [1.20-1.83]), or having higher All-Patient Refined Diagnosis-Related Group severity scores (for severity = 4 vs 1, OR 6.88 [4.99-9.49]) was associated with increased odds of 30-day readmission. After adjusting for insurance status, Asian (OR 1.46 [1.01-2.12]) but not Black or Hispanic, race/ethnicity was associated with greater odds of readmission. Fifteen percent of 172 medical records from a randomly selected month in 2010 documented PCP follow-up plans. After adjusting for demographics, length of stay and severity, documenting PCP follow-up plans was associated with significantly increased odds of 30-day readmission (OR 4.52 [1.01-20.31]).
Conclusion:
Readmission rates are complex quality measures, and documenting primary care follow-up may be associated with higher rather than lower 30-day readmissions. Additional studies are needed to understand the inpatient-outpatient transition.
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