Pediatric hospital discharges to home health and postacute facility care: A national study

Jay G. Berry, Matt Hall, Helene Dumas, Edwin Simpser, Kathleen Whitford, Karen M. Wilson, Margaret O Neill, Vineeta Mittal, Rishi Agrawal, Michael Dribbon, Christopher J. Haines, Christine Traul, Michelle Marks, Jane O'Brien

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

IMPORTANCE Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. OBJECTIVE To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids Inpatient Database. MAIN OUTCOMES AND MEASURES Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes.We compared children s characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. RESULTS The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6%were female. Of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122 673 discharges (5.1%) were to HHC and 26 282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54 589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11 275). When compared with PAC, more discharges to HHC had no chronic condition (34.4%vs 18.0%, P <.001) and fewer discharges to HHC had 4 or more chronic conditions (22.5%vs 37.7%, P <.001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8%vs 1.1%; odds ratio [OR], 0.9 [95%CI, 0.8-0.9]) or HHC (3.3%vs 5.5%; OR, 0.8 [95%CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0%vs 4.4%; OR, 2.9 [95%CI, 2.8-3.0]) and PAC (3.9% vs 0.8%; OR, 4.5 [95%CI, 4.3-4.9]). After case-mix adjustment, there was significant (P <.001) variation across states in HHC (range, 0.4%-24.5%) and PAC (range, 0.4%-4.9%) use. CONCLUSIONS AND RELEVANCE Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.

Original languageEnglish (US)
Pages (from-to)326-333
Number of pages8
JournalJAMA Pediatrics
Volume170
Issue number4
DOIs
StatePublished - Apr 1 2016

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Subacute Care
Pediatric Hospitals
Health Facilities
Home Care Services
Delivery of Health Care
Odds Ratio
Private Duty Nursing
Home Nursing
Risk Adjustment
Centers for Medicare and Medicaid Services (U.S.)
Hospitalized Child
Quality of Health Care
Health Services Research

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Berry, J. G., Hall, M., Dumas, H., Simpser, E., Whitford, K., Wilson, K. M., ... O'Brien, J. (2016). Pediatric hospital discharges to home health and postacute facility care: A national study. JAMA Pediatrics, 170(4), 326-333. https://doi.org/10.1001/jamapediatrics.2015.4836

Pediatric hospital discharges to home health and postacute facility care : A national study. / Berry, Jay G.; Hall, Matt; Dumas, Helene; Simpser, Edwin; Whitford, Kathleen; Wilson, Karen M.; O Neill, Margaret; Mittal, Vineeta; Agrawal, Rishi; Dribbon, Michael; Haines, Christopher J.; Traul, Christine; Marks, Michelle; O'Brien, Jane.

In: JAMA Pediatrics, Vol. 170, No. 4, 01.04.2016, p. 326-333.

Research output: Contribution to journalArticle

Berry, JG, Hall, M, Dumas, H, Simpser, E, Whitford, K, Wilson, KM, O Neill, M, Mittal, V, Agrawal, R, Dribbon, M, Haines, CJ, Traul, C, Marks, M & O'Brien, J 2016, 'Pediatric hospital discharges to home health and postacute facility care: A national study', JAMA Pediatrics, vol. 170, no. 4, pp. 326-333. https://doi.org/10.1001/jamapediatrics.2015.4836
Berry, Jay G. ; Hall, Matt ; Dumas, Helene ; Simpser, Edwin ; Whitford, Kathleen ; Wilson, Karen M. ; O Neill, Margaret ; Mittal, Vineeta ; Agrawal, Rishi ; Dribbon, Michael ; Haines, Christopher J. ; Traul, Christine ; Marks, Michelle ; O'Brien, Jane. / Pediatric hospital discharges to home health and postacute facility care : A national study. In: JAMA Pediatrics. 2016 ; Vol. 170, No. 4. pp. 326-333.
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abstract = "IMPORTANCE Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. OBJECTIVE To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids Inpatient Database. MAIN OUTCOMES AND MEASURES Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes.We compared children s characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. RESULTS The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6{\%}were female. Of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122 673 discharges (5.1{\%}) were to HHC and 26 282 (1.1{\%}) were to PAC facilities. Neonatal care was the most common reason (44.5{\%}, n = 54 589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9{\%}, n = 11 275). When compared with PAC, more discharges to HHC had no chronic condition (34.4{\%}vs 18.0{\%}, P <.001) and fewer discharges to HHC had 4 or more chronic conditions (22.5{\%}vs 37.7{\%}, P <.001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8{\%}vs 1.1{\%}; odds ratio [OR], 0.9 [95{\%}CI, 0.8-0.9]) or HHC (3.3{\%}vs 5.5{\%}; OR, 0.8 [95{\%}CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0{\%}vs 4.4{\%}; OR, 2.9 [95{\%}CI, 2.8-3.0]) and PAC (3.9{\%} vs 0.8{\%}; OR, 4.5 [95{\%}CI, 4.3-4.9]). After case-mix adjustment, there was significant (P <.001) variation across states in HHC (range, 0.4{\%}-24.5{\%}) and PAC (range, 0.4{\%}-4.9{\%}) use. CONCLUSIONS AND RELEVANCE Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.",
author = "Berry, {Jay G.} and Matt Hall and Helene Dumas and Edwin Simpser and Kathleen Whitford and Wilson, {Karen M.} and {O Neill}, Margaret and Vineeta Mittal and Rishi Agrawal and Michael Dribbon and Haines, {Christopher J.} and Christine Traul and Michelle Marks and Jane O'Brien",
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TY - JOUR

T1 - Pediatric hospital discharges to home health and postacute facility care

T2 - A national study

AU - Berry, Jay G.

AU - Hall, Matt

AU - Dumas, Helene

AU - Simpser, Edwin

AU - Whitford, Kathleen

AU - Wilson, Karen M.

AU - O Neill, Margaret

AU - Mittal, Vineeta

AU - Agrawal, Rishi

AU - Dribbon, Michael

AU - Haines, Christopher J.

AU - Traul, Christine

AU - Marks, Michelle

AU - O'Brien, Jane

PY - 2016/4/1

Y1 - 2016/4/1

N2 - IMPORTANCE Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. OBJECTIVE To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids Inpatient Database. MAIN OUTCOMES AND MEASURES Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes.We compared children s characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. RESULTS The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6%were female. Of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122 673 discharges (5.1%) were to HHC and 26 282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54 589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11 275). When compared with PAC, more discharges to HHC had no chronic condition (34.4%vs 18.0%, P <.001) and fewer discharges to HHC had 4 or more chronic conditions (22.5%vs 37.7%, P <.001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8%vs 1.1%; odds ratio [OR], 0.9 [95%CI, 0.8-0.9]) or HHC (3.3%vs 5.5%; OR, 0.8 [95%CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0%vs 4.4%; OR, 2.9 [95%CI, 2.8-3.0]) and PAC (3.9% vs 0.8%; OR, 4.5 [95%CI, 4.3-4.9]). After case-mix adjustment, there was significant (P <.001) variation across states in HHC (range, 0.4%-24.5%) and PAC (range, 0.4%-4.9%) use. CONCLUSIONS AND RELEVANCE Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.

AB - IMPORTANCE Acute care hospitals are challenged to provide efficient, high-quality care to children who have medically complex conditions and may require weeks or months for recovery. Although the use of home health care (HHC) and facility-based postacute care (PAC) after discharge is well documented for adults, to our knowledge, little is known for children. OBJECTIVE To assess the national prevalence of, characteristics of children discharged to, and variation in use across states of HHC and PAC for children. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years from the nationally representative Agency for Healthcare Research and Quality Kids Inpatient Database. MAIN OUTCOMES AND MEASURES Discharges to HHC (eg, visiting or private-duty home nursing) and PAC (eg, rehabilitation facility) were identified from Centers for Medicare and Medicaid Services Discharge Status Codes.We compared children s characteristics (eg, race/ethnicity and number of chronic conditions) by discharge type using generalized linear regression. RESULTS The median age of participants was 3 years (interquartile range, 0-13 years), and 45.6%were female. Of 2 423 031 US acute care hospital discharges in 2012 for patients ages 0 to 21 years, 122 673 discharges (5.1%) were to HHC and 26 282 (1.1%) were to PAC facilities. Neonatal care was the most common reason (44.5%, n = 54 589) for acute care hospitalization with discharge to HHC. Nonneonatal respiratory, musculoskeletal, and trauma-related problems, collectively, were the most common reasons for discharge to PAC (42.9%, n = 11 275). When compared with PAC, more discharges to HHC had no chronic condition (34.4%vs 18.0%, P <.001) and fewer discharges to HHC had 4 or more chronic conditions (22.5%vs 37.7%, P <.001). In multivariable analysis, Hispanic children were less likely to use PAC (0.8%vs 1.1%; odds ratio [OR], 0.9 [95%CI, 0.8-0.9]) or HHC (3.3%vs 5.5%; OR, 0.8 [95%CI, 0.7-0.8]) compared with other children. Children with 4 or more chronic conditions compared with no chronic conditions had a higher likelihood of HHC use (11.0%vs 4.4%; OR, 2.9 [95%CI, 2.8-3.0]) and PAC (3.9% vs 0.8%; OR, 4.5 [95%CI, 4.3-4.9]). After case-mix adjustment, there was significant (P <.001) variation across states in HHC (range, 0.4%-24.5%) and PAC (range, 0.4%-4.9%) use. CONCLUSIONS AND RELEVANCE Home health care and PAC use after discharge for hospitalized children is infrequent, even for children with multiple chronic conditions. It varies significantly by race/ethnicity and across states. Further investigation is needed to assess reasons for this variation and to determine for which children HHC and PAC are most effective.

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