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J Pediatr. 2017 Jul;186:158-164.e1. doi: 10.1016/j.jpeds.2017.03.046. Epub 2017 Apr 21.

Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions.

Author information

1
Division of Hospitalist Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC. Electronic address: kparikh@childrensnational.org.
2
Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA.
3
Children's Hospital Association, Lenexa, KS.
4
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
5
Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO.
6
Children's Health System of Texas and University of Texas Southwestern, Dallas, TX.
7
Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO.
8
Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.

Abstract

OBJECTIVE:

To compare the timing and magnitude of variation of pediatric readmission rates across race/ethnicity for selected chronic conditions: asthma, diabetes, seizures, migraines, and depression.

STUDY DESIGN:

Retrospective analysis of hospitalizations at 48 children's hospitals in the 2013 Pediatric Health Information System database for children (ages 0-18 years) admitted for asthma (n = 36 910), seizure (n = 35 361), diabetes (n = 12 468), migraine (n = 5882), and depression (n = 5132). Generalized linear models with a random effect for hospital were used to compare the likelihood of readmission by patients' race/ethnicity, adjusting for severity of illness, age, payer, and medical complexity. Adjusted readmission rates were calculated by week over 1 year.

RESULTS:

Significant variation in adjusted readmission rates by race/ethnicity existed for conditions aside from depression. Disparities for diabetes and asthma emerged at 3 and 4 weeks, respectively; they remained divergent up to 1 year with the highest 1-year readmission rates in non-Hispanic blacks vs other race/ethnicities (diabetes: 21.7% vs 13.4%, P < .001; asthma: 21.4% vs 14.6%, P < .001). Disparities for migraines and seizure emerged at 6 and 7 weeks, respectively; they remained up to 1 year, with the highest 1-year readmission rates in non-Hispanic whites vs other race/ethnicities (migraine: 17.3% vs 13.6%, P < .001; seizure: 23.9% vs 21.9%, P < .001).

CONCLUSIONS:

Readmission disparities behave differently across chronic conditions. They emerge more quickly after discharge for children hospitalized with asthma or diabetes than for seizures or migraines. The highest readmission rates were not consistently observed for 1 particular race/ethnicity. Study findings can impact pediatric chronic disease management to improve care for children with these conditions.

KEYWORDS:

asthma; children; depression; diabetes; migraine; pediatrics; readmissions; seizures

PMID:
28438375
DOI:
10.1016/j.jpeds.2017.03.046
[Indexed for MEDLINE]

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