Details

Autor(en) / Beteiligte

• Gay, James C., MD, MMHC
• Agrawal, Rishi, MD, MPH
• Auger, Katherine A., MD, MSc
• Del Beccaro, Mark A., MD
• Eghtesady, Pirooz, MD, PhD
• Fieldston, Evan S., MD, MBA, MS
• Golias, Justin, RHIA, CHDA
• Hain, Paul D., MD
• McClead, Richard, MD
• Morse, Rustin B., MD, MMM
• Neuman, Mark I., MD, MPH
• Simon, Harold K., MD, MBA
• Tejedor-Sojo, Javier, MD
• Teufel, Ronald J., MD, MSCR
• Harris, J. Mitchell, PhD
• Shah, Samir S., MD, MSCE

Titel

Rates and Impact of Potentially Preventable Readmissions at Children's Hospitals

Ist Teil von

• The Journal of pediatrics, 2015-03, Vol.166 (3), p.613-619.e5

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2015

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. Study design A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions. Results The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year). Conclusions Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.