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J Pediatr. 2015 Mar;166(3):613-9.e5. doi: 10.1016/j.jpeds.2014.10.052. Epub 2014 Dec 2.

Rates and impact of potentially preventable readmissions at children's hospitals.

Author information

1
Vanderbilt University School of Medicine, Nashville, TN. Electronic address: james.gay@vanderbilt.edu.
2
Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL.
3
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
4
Seattle Children's Hospital, Seattle, WA.
5
Washington University in St. Louis, St. Louis, MO.
6
Children's Hospital of Philadelphia, Philadelphia, PA.
7
National Church Residences, Columbus, OH.
8
University of Texas Southwestern Medical Center, Dallas, TX.
9
Nationwide Children's Hospital, Columbus, OH.
10
Children's Medical Center, Dallas, TX.
11
Boston Children's Hospital, Boston, MA.
12
Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
13
Medical University of South Carolina, Charleston, SC.
14
Children's Hospital Association, Alexandria, VA.

Abstract

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.

PMID:
25477164
DOI:
10.1016/j.jpeds.2014.10.052
[Indexed for MEDLINE]

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