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Ratio of Postdischarge Emergency Department Visits to Readmissions by Diagnosis
Jimin Lee1, Melissa J Fazzari2, Arti D Desai3
1Department of Pediatrics, Weill Cornell Medicine, New York, New York.
Insights
The new ED/READ ratio helps understand pediatric hospital reuse by comparing emergency department visits to readmissions. This metric reveals diagnosis-specific patterns, aiding in identifying areas for healthcare improvement.
Area of Science:
- Pediatric healthcare outcomes
- Healthcare quality improvement
- Health services research
Background:
- Pediatric readmissions and emergency department (ED) visits are key indicators of post-discharge care quality.
- These outcomes are often studied independently but represent a continuum of hospital reuse.
- Existing metrics do not fully capture diagnosis-specific patterns of post-discharge care utilization.
Purpose of the Study:
- To introduce and define the ED/READ ratio as a novel metric for characterizing postdischarge hospital reuse in pediatric populations.
- To analyze diagnosis-specific patterns of ED visits versus readmissions across common pediatric conditions.
- To explore the utility of the ED/READ ratio in identifying potential targets for quality improvement initiatives.
Main Methods:
- A single-center retrospective cohort study included children (0-17 years) discharged between July 2016 and December 2019.
- The 30-day ED/READ ratio was calculated by dividing all-cause postdischarge ED visits by all-cause readmissions for each primary diagnosis.
- The study analyzed diagnoses representing 1% or more of total admissions, computing ratios with 95% confidence intervals.
Main Results:
- The overall 30-day postdischarge ED visit rate was 8.1%, and the readmission rate was 9.2%.
- The ED/READ ratio varied significantly by diagnosis, ranging from 0.08 for chemotherapy to 2.41 for tonsil and adenoid procedures.
- Conditions with ratios >1 included asthma and gastroenteritis, while ratios <1 were observed for chemotherapy and sickle cell anemia crisis.
Conclusions:
- The ED/READ ratio offers a descriptive metric that complements traditional measures of postdischarge care.
- This ratio helps characterize diagnosis-specific patterns of hospital reuse across different care settings.
- Further research is warranted to assess the ED/READ ratio's reproducibility and applicability in diverse healthcare environments.
Background:
Pediatric readmissions and postdischarge emergency department (ED) visits are common measures of postdischarge use and vary across pediatric conditions. Although often studied separately, these outcomes represent a continuum of hospital reuse. We introduce the ED/READ ratio (the ratio of postdischarge ED visits to readmissions) to characterize diagnosis-specific patterns of hospital reuse across common pediatric conditions.
Methods:
In this single-center retrospective cohort study, we included children aged 0 to 17 years discharged from an urban tertiary children's hospital between July 2016 and December 2019. We included primary All-Patient Refined Diagnosis-Related Groups comprising 1% or more of admissions. The primary outcome was the 30-day ED/READ ratio, calculated as the number of all-cause postdischarge ED visits divided by the number of all-cause readmissions within 30 days of discharge, computed for each diagnosis with 95% CIs.
Results:
Among 16 518 hospitalizations from 11 728 patients, the overall 30-day postdischarge ED visit rate was 8.1% and the readmission rate was 9.2%. The 30-day ED/READ ratio ranged from 0.08 (95% CI, 0.05-0.12) for chemotherapy to 2.41 (95% CI, 1.50-3.33) for tonsil and adenoid procedures. Diagnoses with ratios significantly more than 1 included asthma, bronchiolitis and respiratory syncytial virus pneumonia, and gastroenteritis; ratios less than 1 included chemotherapy, sickle cell anemia crisis, and seizures.
Conclusion:
The ED/READ ratio is a descriptive metric that complements traditional measures by characterizing diagnosis-specific patterns of postdischarge reuse across care settings. Used alongside existing metrics, the ratio may help generate hypotheses about diagnosis-specific targets for improvement. Further research is needed to evaluate its reproducibility and applications across diverse settings.
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