Measuring hospital quality using pediatric readmission and revisit rates

Naomi S. Bardach, Eric Vittinghoff, Renée Asteria-Peñaloza, Jeffrey D. Edwards, Jinoos Yazdany, Henry C. Lee, W. John Boscardin, Michael D. Cabana, R. Adams Dudley

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals. METHODS: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level riskstandardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean. RESULTS: Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%). CONCLUSIONS: We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.

Original languageEnglish (US)
Pages (from-to)429-436
Number of pages8
JournalPediatrics
Volume132
Issue number3
DOIs
StatePublished - Sep 1 2013
Externally publishedYes

Fingerprint

Pediatrics
Mood Disorders
Hospital Emergency Service
Inpatients
Low-Volume Hospitals
Pediatric Hospitals
Appendicitis
Child Care
Dehydration
Health Care Costs
Epilepsy
Pneumonia
Asthma
Logistic Models
Databases
Skin
Infection

Keywords

  • Child health research
  • Delivery of care
  • Health policy
  • Hospital performance variation
  • Quality measurement
  • Readmission rates

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Bardach, N. S., Vittinghoff, E., Asteria-Peñaloza, R., Edwards, J. D., Yazdany, J., Lee, H. C., ... Adams Dudley, R. (2013). Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics, 132(3), 429-436. https://doi.org/10.1542/peds.2012-3527

Measuring hospital quality using pediatric readmission and revisit rates. / Bardach, Naomi S.; Vittinghoff, Eric; Asteria-Peñaloza, Renée; Edwards, Jeffrey D.; Yazdany, Jinoos; Lee, Henry C.; John Boscardin, W.; Cabana, Michael D.; Adams Dudley, R.

In: Pediatrics, Vol. 132, No. 3, 01.09.2013, p. 429-436.

Research output: Contribution to journalArticle

Bardach, NS, Vittinghoff, E, Asteria-Peñaloza, R, Edwards, JD, Yazdany, J, Lee, HC, John Boscardin, W, Cabana, MD & Adams Dudley, R 2013, 'Measuring hospital quality using pediatric readmission and revisit rates', Pediatrics, vol. 132, no. 3, pp. 429-436. https://doi.org/10.1542/peds.2012-3527
Bardach NS, Vittinghoff E, Asteria-Peñaloza R, Edwards JD, Yazdany J, Lee HC et al. Measuring hospital quality using pediatric readmission and revisit rates. Pediatrics. 2013 Sep 1;132(3):429-436. https://doi.org/10.1542/peds.2012-3527
Bardach, Naomi S. ; Vittinghoff, Eric ; Asteria-Peñaloza, Renée ; Edwards, Jeffrey D. ; Yazdany, Jinoos ; Lee, Henry C. ; John Boscardin, W. ; Cabana, Michael D. ; Adams Dudley, R. / Measuring hospital quality using pediatric readmission and revisit rates. In: Pediatrics. 2013 ; Vol. 132, No. 3. pp. 429-436.
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abstract = "OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals. METHODS: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level riskstandardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean. RESULTS: Thirty-day readmission rates were low (<10.0{\%}) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2{\%} (appendicitis) to 11.0{\%} (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0{\%}-82.8{\%} of hospitals had <25 visits). The only condition with >1{\%} of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2{\%} of hospitals [n = 15], range of hospital performance 6.3{\%}-15.9{\%}). CONCLUSIONS: We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.",
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