30-day Readmissions for Hospitalized Children: What Are They and What do They Cost?
LewisFirst, MD, MA, Editor in Chief, Pediatrics
With population health becoming more and more the direction that health care is appropriately
taking, finding ways to reduce length of stay or readmissions for a population is
critical to maximizing the health and well-being of that population. But what about
children? How much do we know about readmissions of children who have been hospitalized
in the past month? Markham et al. (10.1542/peds.2017-2934) wanted to know the answer to these questions, and in turn share with us the results
of their retrospective analysis of 30-day readmissions using a national database.
They were able to look at factors such as length of stay and cost of initial admission,
and then do the same for readmissions. The authors review more than 125,000 readmissions
that occurred within 30 days of their first admission and note significant increases
in length of stay (twice as long) when a readmission occurs and with that, total costs
that were also twice as high than for children who did not get readmitted although
variations existed for different diseases when you further break their roll-up data
down. The authors also look at differences in readmissions going to the same or different
hospital and see costs increase when hospitals change. For example, infants with
fever, children with appendicitis, and those with viral gastroenteritis ranked highest
in pediatric readmissions that increased overall length of stay.
What do these findings mean for those of us who are being compensated for population
health—meaning wellness factors and in turn less use of inpatient and emergency care?
Are readmissions really a bad thing for children’s health status? We asked two hospitalists
Drs. Paul Rosenau and Brian Alverson to share their thoughts in an accompanying commentary
(10.1542/peds.2018-0243). They point out that just documenting a readmission without a better understanding
of the social determinants of health in existence for a patient, and whether or not
care-pathways were followed during the index admission can all contribute to factors
that may make a readmission reasonable if factors extrinsic to the disease itself
may make matters worse by not being corrected on that first admission. Using EHRs
to capture quality and standards of care as well as keep track of discharge planning
factors that might prevent a readmission are all aspects of how standardizing our
care practices will in the long run be a better metric to track than readmissions,
given how they can differ by diagnosis. Check out both the article and commentary
and feel free to check them again and again if it will help you admit or readmit that
there is more we can do to insure that we care for the whole child and family during
a hospitalization and not just the disease itself.