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Discharge Medical Complexity, Change in Medical Complexity and Pediatric 30-day Readmission

Katherine A Auger1,2,3, Samir S Shah1,2,3, Bin Huang2,4

  • 1Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

Journal of Hospital Medicine
|August 7, 2019
PubMed

Insights

Pediatric hospital readmissions are linked to polypharmacy and technology use at discharge. However, increased medical complexity during hospitalization does not significantly raise readmission risk when length of stay is considered.

Area of Science:

  • Pediatric healthcare research
  • Hospital readmission analysis
  • Medical complexity assessment

Background:

  • Medical complexity is a known factor in pediatric readmission risk.
  • The impact of *increasing* medical complexity during hospitalization on readmission risk is less understood.

Purpose of the Study:

  • To investigate the association between changes in medical complexity during hospitalization and 30-day unplanned pediatric readmissions.
  • To identify specific complexity factors contributing to readmission risk.

Main Methods:

  • Retrospective case-control study of pediatric hospitalizations over five years.
  • Matched cases (30-day readmission) with controls based on seasonality and proximity to a tertiary children's hospital.
  • Analyzed complexity variables: discharge medications, medical technology, home healthcare, new complex chronic conditions, and new medical technology.

Main Results:

  • Discharge with five or more medications (polypharmacy) increased readmission odds over four-fold.
  • Use of medical technology at discharge was associated with higher readmission odds.
  • New complex chronic conditions and new technology increased readmission risk, but this was not significant when length of stay was factored in.

Conclusions:

  • Polypharmacy and medical technology at discharge are significant risk factors for pediatric readmissions.
  • Increases in medical complexity, such as new diagnoses or technology, do not independently predict readmission risk when length of stay is accounted for.
Abstract

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