Achievable Benchmarks of Care for Pediatric Readmissions
Amanda Montalbano1, Ricardo A Quiñonez2, Matt Hall3
1Division of Urgent Care and Department of Pediatrics, Children's Mercy Hospital, University of Missouri, Kansas City, Missouri.
Insights
Pediatric readmission rates vary by hospital type. Sickle cell disease and mental health disorders show higher rates, indicating key areas for quality improvement in children's healthcare.
Area of Science:
- Pediatric healthcare quality
- Hospital performance metrics
- Healthcare utilization research
Background:
- Most pediatric inpatient care occurs outside specialized children's hospitals.
- Quality metrics are often set by tertiary facilities, not reflecting broader care settings.
- Understanding readmission rates across different hospital types is crucial for equitable quality assessment.
Purpose of the Study:
- To calculate mean readmission rates and Achievable Benchmarks of Care (ABCs) for pediatric diagnoses.
- To compare these metrics across metropolitan teaching, metropolitan nonteaching, and nonmetropolitan hospitals.
- To identify variations in pediatric inpatient care quality by hospital type.
Main Methods:
- Cross-sectional retrospective study using the 2014 Healthcare Utilization Project National Readmission Database.
- Analysis of 30-day, all-cause, same-hospital readmissions for patients under 18.
- Calculation of mean readmission rates and ABCs for the 17 most common pediatric readmission diagnoses by hospital type.
Main Results:
- Analysis included 690,949 pediatric discharges across 525 metropolitan teaching, 552 metropolitan nonteaching, and 587 nonmetropolitan hospitals.
- Sickle cell disease (SCD) exhibited the highest readmission rates and ABCs across all hospital types.
- Outlier hospitals, performing worse than benchmarks, were prominent for bipolar disorders, major depressive disorders, and SCD.
Conclusions:
- Hospital-type-specific Achievable Benchmarks of Care (ABCs) may better account for case-mix variation in pediatric inpatient care.
- Elevated mean rates and ABCs for SCD and mental health disorders highlight these as critical targets for quality improvement initiatives.
- Standardized quality metrics need to consider the diverse settings where pediatric care is delivered.
Background:
Most inpatient care for children occurs outside tertiary children's hospitals, yet these facilities often dictate quality metrics. Our objective was to calculate the mean readmission rates and the Achievable Benchmarks of Care (ABCs) for pediatric diagnoses by different hospital types: metropolitan teaching, metropolitan nonteaching, and nonmetropolitan hospitals.
Methods:
We used a cross-sectional retrospective study of 30-day, all-cause, same-hospital readmission of patients less than 18 years old using the 2014 Healthcare Utilization Project National Readmission Database. For each hospital type, we calculated the mean readmission rates and corresponding ABCs for the 17 most common readmission diagnoses. We define outlier as any hospital whose readmission rate fell outside the 95% CI for an ABC within their hospital type.
Results:
We analyzed 690,949 discharges at 525 metropolitan teaching hospitals (550,039 discharges), 552 metropolitan nonteaching hospitals (97,207 discharges), and 587 nonmetropolitan hospitals (43,703 discharges). Variation in readmission rates existed among hospital types; however, sickle cell disease (SCD) had the highest readmission rate and ABC across all hospital types: metropolitan teaching hospitals 15.7% (ABC 7.0%), metropolitan nonteaching 14.7% (ABC 2.6%), and nonmetropolitan 12.8% (ABC not calculated). For diagnoses in which ABCs were available, outliers were prominent in bipolar disorders, major depressive disorders, and SCD.
Conclusions:
ABCs based on hospital type may serve as a better metric to explain case-mix variation among different hospital types in pediatric inpatient care. The mean rates and ABCs for SCD and mental health disorders were much higher and with more outlier hospitals, which indicate high-value targets for quality improvement.
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