Rates and impact of potentially preventable readmissions at children's hospitals

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Hospital Readmissions

Background:

• Hospital readmissions represent a significant cost and quality metric in pediatric care.
• Identifying preventable readmissions is crucial for optimizing resource allocation and improving patient outcomes.
• The 3M-Potentially Preventable Readmissions (3M-PPRs) software is a tool used to categorize readmissions.

Purpose of the Study:

• To evaluate the rates, diagnoses, and associated costs of potentially preventable readmissions (PPRs) in a national cohort of children's hospitals.
• To compare PPR rates with all-cause readmission rates.
• To identify specific conditions and procedures associated with high rates of potentially preventable readmissions.

Main Methods:

• Analysis of 1,719,617 hospitalizations for 1,531,828 unique patients across 58 children's hospitals.
• Data collected from the Children's Hospital Association Case-Mix Comparative database between 2009 and 2011.
• Utilized 3M-PPRs software to identify and categorize readmissions at 7, 15, and 30 days post-discharge.

Main Results:

• Potentially preventable readmission (PPR) rates at 7, 15, and 30 days were 2.5%, 4.1%, and 6.2%, respectively, significantly lower than all-cause readmission rates (5.0%, 8.7%, 13.3%).
• Malignancies accounted for over half of non-preventable readmissions.
• Conditions like sickle cell crisis, asthma, and ventricular shunt procedures showed high percentages of potentially preventable readmissions, contributing significantly to costs.

Conclusions:

• PPR rates are substantially lower than all-cause readmission rates in children's hospitals, with malignancies being a key factor in non-preventable readmissions.
• While aggregate costs of PPRs are significant, they represent a smaller cost-saving opportunity in pediatrics compared to adults.
• Findings can guide children's hospitals in targeting readmission reduction strategies toward high-cost, high-vulnerability areas identified by 3M-PPRs.