Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates
OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals.
METHODS: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1–20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.
RESULTS: Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%–82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%–15.9%).
CONCLUSIONS: We found that when comparing hospitals’ performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.
- readmission rates
- hospital performance variation
- quality measurement
- child health research
- delivery of care
- health policy
- AHA —
- American Hospital Association
- APR-DRG —
- All-Patient Refined Diagnosis Related Group
- BLUP —
- best linear unbiased prediction
- CCC —
- complex chronic condition
- CCS —
- Clinical Classification Software
- CI —
- confidence interval
- CMS —
- Centers for Medicare and Medicaid Services
- ED —
- emergency department
- ICD-9 —
- International Classification of Diseases, Ninth Revision
- OR —
- odds ratio
- Accepted May 30, 2013.
- Copyright © 2013 by the American Academy of Pediatrics