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Performance of Pediatric Readmission Measures
Katherine A Auger1,2,3, Michael C Ponti-Zins4, Angela M Statile1,2,3
1Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Existing pediatric readmission metrics fail to reliably identify preventable hospital readmissions. The unplanned readmission/time flag measure shows promise for accurately tracking unplanned pediatric readmissions.
Area of Science:
- Pediatric Quality Metrics
- Healthcare Readmission Analysis
Background:
- Hospital readmission rates are key quality indicators, but multiple pediatric measures exist.
- Current metrics may not accurately reflect preventable or unplanned pediatric readmissions.
Purpose of the Study:
- To compare four distinct pediatric readmission measures.
- To assess the accuracy of these measures in identifying preventable and unplanned readmissions.
Main Methods:
- Clinicians reviewed 1,125 pediatric 30-day readmissions (July 2014-June 2016).
- Readmissions were classified as preventable/not preventable and planned/unplanned.
- Sensitivity and specificity were calculated for four existing metrics against clinical review.
Main Results:
- Most readmissions (85%) were not preventable; only 15% were unplanned and preventable.
- No existing metric reliably identified preventable readmissions.
- The unplanned readmission/time flag metric demonstrated high sensitivity (95%) and specificity (90%) for unplanned readmissions.
Conclusions:
- Existing pediatric readmission measures lack reliability for assessing preventability.
- The unplanned readmission/time flag metric is the most effective for identifying unplanned pediatric readmissions.
Background:
Readmission rates are frequently used as a hospital quality metric; yet multiple measures exist to evaluate pediatric readmission rates. We sought to assess how four different measures of pediatric readmission compare with assessment of both preventable and unplanned readmission.
Methods:
Clinicians on hospital medicine, cardiology, neonatology, and neurology teams reviewed medical records for 30-day readmissions using an abstraction tool with high interrater reliability for preventability assessment. Readmissions between July 2014 and June 2016 were classified separately as preventable or not preventable and planned or unplanned. We compared the classifications to four existing readmission metrics: all-cause readmission, unplanned readmission/time flag classification, the pediatric all-condition readmission, and potentially preventable readmission. We calculated sensitivity and specificity for all readmission metrics.
Results:
Among 30-day readmissions considered, 1,643 were eligible for medical record review; 1,125 reviews were completed by the clinical teams (68%). On medical record review, the majority of readmissions were determined not preventable (85%). Only 15% were classified as unplanned and preventable. None of the four readmission measures had appropriate sensitivity or specificity for identifying preventable readmission. The unplanned readmission/time flag classification had the highest sensitivity (95%) and specificity (90%) in identifying unplanned readmissions.
Conclusion:
None of the existing pediatric readmission measures can reliably determine preventability. The unplanned readmission/time flag measure performed best in identifying unplanned readmissions.
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