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Acad Pediatr. 2014 Sep-Oct;14(5 Suppl):S39-46. doi: 10.1016/j.acap.2014.06.012.

Measuring pediatric hospital readmission rates to drive quality improvement.

Author information

1
Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: mari.nakamura@childrens.harvard.edu.
2
Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
3
Department of Health Care Policy, Harvard Medical School, Boston, Mass.
4
Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
5
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
6
Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass; Division of General Medicine, Brigham and Women's Hospital, Boston, Mass; Veterans Affairs Boston Healthcare System, Boston, Mass.

Abstract

The Pediatric Quality Measures Program is developing readmission measures for pediatric use. We sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. We consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and current knowledge gaps. The major topic of debate regarding readmission rates as pediatric quality measures is the relative influence of hospital quality versus other factors within and outside of health systems on readmission risk. The complex causation of readmissions leads to disagreement, particularly when rates are publicly reported or tied to payment, about whether readmissions can be prevented and how to achieve fair comparisons of readmission performance. Despite these controversies, the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes. Many adult studies demonstrate a link between successful initiatives to improve quality and reductions in readmissions. More research is needed on methods to enhance adjustment of readmission rates and on how to prevent pediatric readmissions.

KEYWORDS:

pediatrics; quality measurement; readmissions

PMID:
25169456
DOI:
10.1016/j.acap.2014.06.012
[Indexed for MEDLINE]

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