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Is a readmission risk score necessary for patients with complex chronic conditions?
Jimena Pérez-Moreno1, Emiliana Armas Castillo1, Juan José Escalonilla García1
1Hospitalización de Pediatría, Servicio de Pediatría y sus Áreas Específicas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Introduction:
The HOSPITAL score is a tool that assesses the risk of readmission, but it considers oncological disease as the sole chronic condition category linked to readmission risk. In pediatrics, there is no score that includes children with medical complexity (CMC).
Objective:
The objective of this study was to analyze the clinical characteristics of all non-oncological pediatric readmissions and to describe risk factors for readmission of CMC.
Methods:
We conducted a retrospective and analytical study of readmissions to the pediatric wards of a tertiary hospital (January 2021-June 2023). Readmission was defined as occurring within 30 days of discharge. We compared variables from the HOSPITAL score and the PEDCOM score in patients with chronic and acute conditions.
Results:
The analysis included 241 readmissions; 41.5% were CMC readmissions. Readmitted CMCs were older, predominantly male (76%), and were readmitted more frequently due to worsening of their underlying disease and for the same reason as the first admission (26% vs 7.1%; P<.01) compared to acute patients. Both the HOSPITAL (5 [3-7] vs 2 [1-4]; P<.01) and PEDCOM (9 [5-14] vs 1 [0-2]; P<.01) scores were higher in the readmitted CMC group. Children with complex chronic disease that have higher PedCom scores are at increased risk of potentially preventable readmission.
Conclusions:
Hospital readmissions of CMC patients have different characteristics that must be taken into account for the implementation of preventive measures to avoid readmission.
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