Hospital readmission rates are increasingly used to assess quality of care. Little is known, however, about the potential preventability of readmissions among children. Researchers from Harvard Medical School and Yale University School of Medicine have evaluated the potential preventability of 30-day pediatric readmissions at Boston’s Children Hospital. Their findings were published online in Pediatrics.
The investigators conducted a cross-sectional study of 305 children (less than 18 years of age) who were readmitted within 30 days between December 2012 and February 2013.Interviews were conducted with 1,459 parents or guardians, patients (if 13 years of age or older), inpatient clinicians, and primary care providers. The researchers also evaluated medical records, interview summaries, and transcripts, and then rated the potential preventability of readmissions.
They found that 29.5% of readmissions were potentially preventable. Such readmissions occurred sooner after discharge than did non–potentially preventable readmissions (a median of five days vs. nine days, respectively; P < 0.001). In more than 75% of those cases, the researchers determined that hospital-related factors played a role. Significantly fewer cases were related to the patient (39.2%), often because of issues that arose after discharge, or to the primary care physician (14.5%). Multiple factors played a role in some patients’ readmissions, so the total exceeds 100%.
The most common hospital-related reasons for readmissions had to do with how patients were assessed and with postoperative complications or hospital-acquired conditions.
The odds of a readmission being potentially preventable were greatest when the index admission and readmission were causally related (adjusted odds ratio [AOR], 2.6) and when hospital (AOR, 16.3) or patient (AOR, 7.1) factors were identified. Interviews provided new information about the readmission in 31.2% of cases.
The Centers for Medicare and Medicaid Services doesn’t penalize hospitals for pediatric readmissions, but a growing number of states are doing so, the study found.
“One of the things we need to improve upon is engaging families at the time of discharge around how we’re feeling and how they’re feeling about the status of the child at that point in time,” lead author Dr. Sara Toomey told HealthLeaders Media.
Readmissions will never be completely avoidable, Toomey said. Still, “when you have a child coming home from the hospital, there are things you need to know, and the more active people are in creating a plan and making sure they understand it, the better that will help their children.”