Rates and impact of potentially preventable readmissions at children's hospitals

James C. Gay, Rishi Agrawal, Katherine A. Auger, Mark A. Del Beccaro, Pirooz Eghtesady, Evan S. Fieldston, Justin Golias, Paul D. Hain, Richard McClead, Rustin B. Morse, Mark I. Neuman, Harold K. Simon, Javier Tejedor-Sojo, Ronald J. Teufel, J. Mitchell Harris, Samir S. Shah

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Objective To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. Study design A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions. Results The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year). Conclusions Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.

Original languageEnglish (US)
Pages (from-to)613-619
Number of pages7
JournalJournal of Pediatrics
Volume166
Issue number3
DOIs
StatePublished - Mar 1 2015

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Software
Costs and Cost Analysis
Bronchiolitis
Appendectomy
Cost Savings
Diagnosis-Related Groups
Cystic Fibrosis
Neoplasms
Leukemia
Seizures
Hospitalization
Asthma
Outcome Assessment (Health Care)
Databases
Drug Therapy

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Gay, J. C., Agrawal, R., Auger, K. A., Del Beccaro, M. A., Eghtesady, P., Fieldston, E. S., ... Shah, S. S. (2015). Rates and impact of potentially preventable readmissions at children's hospitals. Journal of Pediatrics, 166(3), 613-619. https://doi.org/10.1016/j.jpeds.2014.10.052

Rates and impact of potentially preventable readmissions at children's hospitals. / Gay, James C.; Agrawal, Rishi; Auger, Katherine A.; Del Beccaro, Mark A.; Eghtesady, Pirooz; Fieldston, Evan S.; Golias, Justin; Hain, Paul D.; McClead, Richard; Morse, Rustin B.; Neuman, Mark I.; Simon, Harold K.; Tejedor-Sojo, Javier; Teufel, Ronald J.; Mitchell Harris, J.; Shah, Samir S.

In: Journal of Pediatrics, Vol. 166, No. 3, 01.03.2015, p. 613-619.

Research output: Contribution to journalArticle

Gay, JC, Agrawal, R, Auger, KA, Del Beccaro, MA, Eghtesady, P, Fieldston, ES, Golias, J, Hain, PD, McClead, R, Morse, RB, Neuman, MI, Simon, HK, Tejedor-Sojo, J, Teufel, RJ, Mitchell Harris, J & Shah, SS 2015, 'Rates and impact of potentially preventable readmissions at children's hospitals', Journal of Pediatrics, vol. 166, no. 3, pp. 613-619. https://doi.org/10.1016/j.jpeds.2014.10.052
Gay JC, Agrawal R, Auger KA, Del Beccaro MA, Eghtesady P, Fieldston ES et al. Rates and impact of potentially preventable readmissions at children's hospitals. Journal of Pediatrics. 2015 Mar 1;166(3):613-619. https://doi.org/10.1016/j.jpeds.2014.10.052
Gay, James C. ; Agrawal, Rishi ; Auger, Katherine A. ; Del Beccaro, Mark A. ; Eghtesady, Pirooz ; Fieldston, Evan S. ; Golias, Justin ; Hain, Paul D. ; McClead, Richard ; Morse, Rustin B. ; Neuman, Mark I. ; Simon, Harold K. ; Tejedor-Sojo, Javier ; Teufel, Ronald J. ; Mitchell Harris, J. ; Shah, Samir S. / Rates and impact of potentially preventable readmissions at children's hospitals. In: Journal of Pediatrics. 2015 ; Vol. 166, No. 3. pp. 613-619.
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AU - Gay, James C.

AU - Agrawal, Rishi

AU - Auger, Katherine A.

AU - Del Beccaro, Mark A.

AU - Eghtesady, Pirooz

AU - Fieldston, Evan S.

AU - Golias, Justin

AU - Hain, Paul D.

AU - McClead, Richard

AU - Morse, Rustin B.

AU - Neuman, Mark I.

AU - Simon, Harold K.

AU - Tejedor-Sojo, Javier

AU - Teufel, Ronald J.

AU - Mitchell Harris, J.

AU - Shah, Samir S.

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N2 - Objective To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. Study design A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions. Results The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year). Conclusions Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.

AB - Objective To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals. Study design A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions. Results The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year). Conclusions Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.

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