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Admissions to Acute Care Within 30 and 90 Days of Discharge Home From a Pediatric Post-acute Care Hospital
Jane E O'Brien1,2, Helene M Dumas3, Maria A Fragala-Pinkham1
1Franciscan Hospital for Children, Boston, Massachusetts; and.
Insights
Most children with medical complexity discharged from post-acute care hospitals (PACH) do not require readmission. However, children with higher medical severity face a greater risk of readmission within 90 days.
Area of Science:
- Pediatric Hospital Medicine
- Healthcare Management
- Patient Outcomes
Background:
- Children with medical complexity (CMC) have high hospital readmission rates.
- Post-acute hospital care (PACH) may improve health stability for CMC.
- Understanding readmission risks after PACH is crucial for care coordination.
Purpose of the Study:
- To determine the frequency of acute care hospital readmissions for CMC after PACH discharge.
- To identify factors associated with readmission within 90 days post-PACH.
Main Methods:
- Retrospective cohort analysis of 448 CMC discharged from PACH (2010-2015).
- Examined acute care readmissions at 0-30 and 31-90 days post-discharge.
- Compared demographic and clinical characteristics between readmitted and non-readmitted children.
Main Results:
- 22% of CMC were readmitted to acute care.
- 62% of readmissions occurred within 30 days of PACH discharge.
- Children with high medical severity (≥3 systems or ventilator dependent) were more likely to be readmitted (68% vs. 31%).
Conclusions:
- Most CMC discharged from PACH avoid acute care readmission within 3 months.
- Increased medical severity is a significant predictor of readmission for CMC post-PACH.
- Targeted interventions for high-risk CMC may reduce readmission rates.
Objectives:
Of all hospitalized children, those with medical complexity have the highest likelihood of hospital readmission. Post-acute hospital care could potentially help stabilize the health of these children. We examined the frequency of acute care hospital admissions after discharge home from a post-acute care hospital (PACH).
Methods:
A retrospective cohort analysis of 448 children with medical complexity discharged from a PACH from January 1, 2010, to December 31, 2015, with the main outcomes of acute care hospital readmissions 0 to 30 and 31 to 90 days after discharge home from a PACH. Demographic and clinical characteristics were compared between children with and without acute care readmission and between the 2 readmission groups.
Results:
Ninety-nine children (22%) had a readmission to the acute care hospital. Of these readmissions, 61 (62%) occurred between 0 and 30 days and 38 (38%) between 31 and 90 days after PACH discharge. A higher percentage of children readmitted had high medical severity (>3 systems involved or ventilator dependent) compared with children not readmitted (68% vs 31%, P = .04). No differences were found between children who were readmitted and those who were not by sex, race, payer, length of stay, or age at PACH discharge. Additionally, no differences were found between children readmitted within 30 days and children readmitted 31 to 90 days after PACH discharge.
Conclusions:
The majority of children discharged home from a PACH do not require an acute care hospitalization within the first 3 months. Children with greater medical severity are readmitted more often than others.
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