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Journal of Pediatrics, The

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Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions - 14/12/17

Doi : 10.1016/j.jpeds.2017.03.046 
Kavita Parikh, MD, MSHS 1, * , Jay Berry, MD 2, Matt Hall, PhD 3, Grant M. Mussman, MD, MHSA 4, Amanda Montalbano, MD, MPH 5, Joanna Thomson, MD, MPH 4, Rustin Morse, MD 6, Karen M. Wilson, MD, MPH 7, *, Samir S. Shah, MD, MSCE 8
1 Division of Hospitalist Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC 
2 Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA 
3 Children's Hospital Association, Lenexa, KS 
4 Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 
5 Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO 
6 Children's Health System of Texas and University of Texas Southwestern, Dallas, TX 
7 Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO 
8 Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 

*Reprint requests: Kavita Parikh, MD, MSHS, Division of Hospitalist Medicine, Department of Pediatrics, Children's National Medical Center, George Washington School of Medicine, 111 Michigan Ave NW, Washington, DC 20010.Division of Hospitalist MedicineDepartment of PediatricsChildren's National Medical CenterGeorge Washington School of Medicine111 Michigan Ave NWWashingtonDC20010

Abstract

Objective

To compare the timing and magnitude of variation of pediatric readmission rates across race/ethnicity for selected chronic conditions: asthma, diabetes, seizures, migraines, and depression.

Study design

Retrospective analysis of hospitalizations at 48 children's hospitals in the 2013 Pediatric Health Information System database for children (ages 0-18 years) admitted for asthma (n = 36 910), seizure (n = 35 361), diabetes (n = 12 468), migraine (n = 5882), and depression (n = 5132). Generalized linear models with a random effect for hospital were used to compare the likelihood of readmission by patients' race/ethnicity, adjusting for severity of illness, age, payer, and medical complexity. Adjusted readmission rates were calculated by week over 1 year.

Results

Significant variation in adjusted readmission rates by race/ethnicity existed for conditions aside from depression. Disparities for diabetes and asthma emerged at 3 and 4 weeks, respectively; they remained divergent up to 1 year with the highest 1-year readmission rates in non-Hispanic blacks vs other race/ethnicities (diabetes: 21.7% vs 13.4%, P < .001; asthma: 21.4% vs 14.6%, P < .001). Disparities for migraines and seizure emerged at 6 and 7 weeks, respectively; they remained up to 1 year, with the highest 1-year readmission rates in non-Hispanic whites vs other race/ethnicities (migraine: 17.3% vs 13.6%, P < .001; seizure: 23.9% vs 21.9%, P < .001).

Conclusions

Readmission disparities behave differently across chronic conditions. They emerge more quickly after discharge for children hospitalized with asthma or diabetes than for seizures or migraines. The highest readmission rates were not consistently observed for 1 particular race/ethnicity. Study findings can impact pediatric chronic disease management to improve care for children with these conditions.

Le texte complet de cet article est disponible en PDF.

Keywords : asthma, diabetes, seizures, migraine, depression, readmissions, children, pediatrics

Abbreviations : APR-DRG, CCC, LOS, PHIS


Plan


 Supported by the Agency for Healthcare Research and Quality (K08HS024554 [to K.P.]). The authors declare no conflicts of interest.


© 2017  Elsevier Inc. Tous droits réservés.
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Vol 186

P. 158 - juillet 2017 Retour au numéro
Article précédent Article précédent
  • Adding Social Determinant Data Changes Children's Hospitals' Readmissions Performance
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