Hospital readmissions—patients who have to check back into the hospital unexpectedly within 30 days of going home—have become an important factor in determining the quality of health care, particularly since Medicare is using that data to compensate and penalize hospital performance in its Hospital Readmissions Reduction Program.
But not much attention has been paid to hospital readmissions for children.
A new study, however, has found that trends seen in adult hospital readmissions also apply to pediatric readmissions. Published in the Journal of the American Medical Association (JAMA), the study found that 1 in 15 children discharged from a pediatric hospital is readmitted.
Researchers at Boston Children’s Hospital examined data from the National Association of Children’s Hospitals and Related Institutions for 72 large acute-care children’s hospitals between July 2009 and June 2010.
As reported on MedCityNews.com, the most common problems that returned young patients to the hospital were anemia/neutropenia (low white blood cell count), ventricular shunt procedures (to drain fluid around the brain) and sickle-cell crises. The incidence of readmission for those complications was comparable to the rate for adults readmitted for heart attack, heart failure and pneumonia.
So, many readmission trends seen in adults also are seen in children—similar rates related to certain conditions. Just like with adults, most pediatric patients are readmitted because they suffer from chronic diseases.
As noted in an editorial accompanying the JAMA study, most children are hospitalized only once in their lives—when they are born. Excluding newborns, every year about 3.6 million people are hospitalized, almost one-third of whom are children. But only a small percentage of children account for the majority of hospital admissions and costs—the ones with complicated medical problems.
Their larger use of health-care resources mirrors that of people on Medicare, whose chronic, complicated problems require more resources, and result in more readmissions.
Rates varied among the hospitals surveyed, and ranged from 4.6 to 8.5 in 100, depending on factors such as differences in hospital and follow-up care and family or community influences on health, the researchers said. Bottom line: There’s room for improvement, but it’s not just about hospitals doing a better job of treating inpatients and communicating with them on discharge, which is known as transition care.
“Community clinicians and organizations have a role to play as well,” said Dr. Mark Schuster, chief of general pediatrics at Boston Children’s Hospital in a statement released with the study. “Parents also need support in being able to stay home with their recuperating children.”
As noted by MedCityNews, this study found results similar to one that examined readmissions in VA hospitals in that a shorter hospital stay was associated with lower rates of readmission. And as you might expect, readmissions are higher for children with no insurance or with public coverage.
Critics of the Hospital Readmission Reductions Program say that you can’t use numbers alone to determine why some hospitals have higher readmission rates than others—some serve populations that lack primary care that might have addressed problems before they became serious enough to require hospitalization, so they’re treating a sicker patient population. Some are located in areas with higher trauma and crime rates, which mean they see more people with critical care issues.
The JAMA editorial acknowledged these complications as they apply to pediatric readmissions. “Until research can demonstrate that hospitals that have high pediatric readmissions are delivering suboptimal quality as opposed to caring for more children with complex social environments that contribute to readmission,” the authors wrote, “physicians and policy makers should not consider pediatric readmissions as a quality indicator: current research only supports it as a marker of health care utilization.”
“Are pediatric readmissions ready to debut as a showcase hospital quality measure?” the writers ask. “At this point, the answer is no. Or at least not yet.”
But that doesn’t mean that you can’t help your child get the best possible hospital care. Mindful of the factors that can skew pure numbers, you can find out how many hospitals rate on Medicare’s Hospital Compare site.
Another method of hospital review is described in our previous blog about performance ratings. Also, read my two-part newsletter about how to keep a loved one safe during hospitalization here and here.