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Rehospitalization for childhood asthma: timing, variation, and opportunities for intervention
Chén C Kenyon1, Patrice R Melvin2, Vincent W Chiang3
1Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA; Division of General Pediatrics, Boston Children's Hospital, Boston, MA.
Insights
Pediatric asthma rehospitalization rates vary significantly across hospitals. Disparities based on race and insurance emerge by 60 days, highlighting the need for improved post-hospitalization care.
Area of Science:
- Pediatric Pulmonology
- Healthcare Quality Improvement
- Health Services Research
Background:
- Pediatric asthma rehospitalization is a significant concern impacting healthcare costs and patient outcomes.
- Understanding the temporal patterns and hospital variations in rehospitalization is crucial for targeted interventions.
Purpose of the Study:
- To analyze the timing of pediatric asthma rehospitalizations.
- To identify variations in rehospitalization rates among children's hospitals.
- To determine factors associated with rehospitalization at different time points.
Main Methods:
- Retrospective cohort analysis of 44,204 pediatric asthma hospitalizations across 42 children's hospitals (July 2008 - June 2011).
- Outcome measures included rehospitalization for asthma at 7, 15, 30, 60, 180, and 365 days post-discharge.
- Analysis of demographic, clinical, and hospital-level factors influencing rehospitalization.
Main Results:
- Asthma rehospitalization rates increased from 0.5% at 7 days to 17.2% at 365 days.
- Black patients and those with public insurance showed higher rehospitalization odds beyond 60 days.
- Adolescents, patients with complex chronic conditions, and those with prior asthma admissions had increased odds of rehospitalization at all intervals.
- Significant, case-mix adjusted hospital variations in rehospitalization rates were observed at all time points.
Conclusions:
- Substantial variation exists in pediatric asthma rehospitalization rates across hospitals, persisting up to one year.
- Racial/ethnic and socioeconomic disparities in rehospitalization become evident by 60 days.
- By one year, rehospitalizations constitute a substantial proportion (1 in 6) of all asthma admissions, underscoring the need for extended post-discharge care strategies.
Objective:
To assess the timing of pediatric asthma rehospitalization, variation in rate of rehospitalization across hospitals, and factors associated with rehospitalization at different intervals.
Study Design:
Retrospective cohort analysis of 44,204 hospitalizations for children with asthma within 42 children's hospitals between July 2008 and June 2011. The main outcome measures were rehospitalization for asthma within 7, 15, 30, 60, 180, and 365 days of an index asthma admission.
Results:
The rate of asthma rehospitalization ranged from 0.5% (n = 208) at 7 days to 17.2% (n = 7603) at 365 days. Black patients and patients with public insurance had higher odds of rehospitalization at 60 days and beyond (P ≤ .01 for both). Adolescents (12- to 18-year-old), patients with a diagnosis of a complex chronic condition, and patients with a prior year asthma admission had higher odds of rehospitalization at every time interval (P ≤ .001 for all). Significant hospital variation in case-mix adjusted rates of rehospitalization existed at each time interval (P ≤ .01 for all). Rates at 365 days were ≤ 10.9% for the top 10% of hospitals; if all hospitals achieved this rate, 36.6% of rehospitalizations might have been avoided.
Conclusions:
Significant variation in asthma rehospitalization rates exists across children's hospitals from 7 to 365 days after an index admission. Racial/ethnic and economic disparities emerge at 60 days. By 1 year, rehospitalizations account for 1 in 6 hospitalizations. Assessing asthma rehospitalizations at longer intervals may augment our current understanding of and approach to post-hospitalization care improvement.
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