Annual Report on Healthcare for Children and Youth in the United States: Focus on 30-day unplanned inpatient readmissions, 2009-2014.

TitleAnnual Report on Healthcare for Children and Youth in the United States: Focus on 30-day unplanned inpatient readmissions, 2009-2014.
Publication TypeJournal Article
Year of Publication2018
AuthorsHeslin KC, Owens PL, Simpson LA, Guevara JP, McCormick MC
JournalAcad Pediatr
Date Published2018 Jul 19
ISSN1876-2867
Abstract

OBJECTIVE: The aim of this study is to describe trends in unplanned 30-day all-condition hospital readmissions for children aged 1 to 17 years between 2009 and 2014.

STUDY DESIGN: Analysis was conducted with the 2009-2014 Nationwide Readmissions Database (NRD) from the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project. Annual hospital readmission rates, resource use, and the most common reasons for readmission were calculated for the 2009-2014 period.

RESULTS: The rate of readmission for children aged 1 to 17 years was essentially stable between 2009 and 2014, (5.5% in 2009 to 5.9% in 2014). In 2009, the most common reason (principal diagnosis) for readmission was sickle cell anemia, whereas in 2014 the most common reason was epilepsy. Pneumonia fell from the second to the sixth most common reason for readmission over this time period (from 3,832 to 2,418 stays). Other respiratory infections were among the top 10 principal readmission diagnoses in 2009, but not in 2014. Septicemia was among the 10 most common reasons for readmission in 2014, but not in 2009. Although the average costs of index (i.e. initial) stays with a subsequent readmission were similar in 2009 and 2014, the average costs of index stays without a readmission and costs of readmission stays increased about 23%. In both 2009 and 2014, the average costs of the index stays with a subsequent readmission were 73% to 89% higher than index stays of children who were not readmitted within 30 days. The average costs of index stays preceding a readmission were 33% to 45% higher than average costs for readmitted stays. In 2014, the aggregate cost of index stays plus readmissions was $1.58 billion, with 42.9% of the costs attributable to readmissions. Regarding average costs and lengths of stay for the 10 most common readmission diagnoses, in 2009 the average cost per stay for complications of devices, implants or grafts was nearly five times greater than that of asthma ($21,200 vs. $4,500, respectively). In 2014, average costs per stay ranged from $5,500 for asthma to $39,500 for septicemia. In 2009, the average length of stay for complications of devices, implants or grafts was over three times higher than that for asthma (7.8 vs. 2.5 days, respectively), and, in 2014, the average length of stay for septicemia was nearly four times higher than that for asthma (10.4 vs. 2.6 days).

CONCLUSIONS/IMPLICATIONS: This study provides a baseline assessment for examining trends in 30-day unplanned pediatric readmissions, an important quality metric as the provisions of the Children's Health Insurance Program Reauthorization Act and the Affordable Care Act are changed and implemented in the future. Over 50,000 pediatric hospital stays in 2014 occurred within 30 days of a previous hospitalization, with an average cost of $13,800. This report is timely, as the health care system works to become more patient-centered and public and private payers grapple with how to pay for quality care for children. The report provides baseline information that can be used to further explore ways to reduce unplanned readmissions.

DOI10.1016/j.acap.2018.06.006
Alternate JournalAcad Pediatr
PubMed ID30031903