State-Level Child Health System Performance and the Likelihood of Readmission to Children's Hospitals - 07/03/14
, Susmita Pati, MD, MPH a, Denise M. Goodman, MD, MS c, Michael G. Kahn, MD, PhD d, Vidya Sharma, MBBS, MPH e, Jack H. Hutto, MD f, James E. Levin, MD, PhD g, Anthony D. Slonim, MD, DrPH h, Matt Hall, PhD i, Samir S. Shah, MD, MSCE b
Reprint requests: Chris Feudtner, MD, PhD, MPH, General Pediatrics–3535 Market, Room 1523, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104.Résumé |
Objectives |
To assess the relationship between children's hospital readmission and the performance of child health systems in the states in which hospitals are located.
Study design |
We conducted a retrospective cohort study of 197 744 patients 2 to 18 years old from 39 children's hospitals located in 24 states in the United States in 2005. Subjects were observed for a year after discharge for readmission to the same hospital. The odds of readmission were modeled on the basis of patient-level characteristics and state child health system performance as ranked by the Commonwealth Fund.
Results |
A total of 1.8% of patients were readmitted within a week, 4.8% within a month, and 16.3% within 365 days. After adjustment for patient-level characteristics, the probability of readmission varied significantly between states (P = .001), and the likelihood of readmission during the ensuing year increased as the states' health system performance ranking improved. States in the best ranking quartile had a 2.03% higher readmission rate than states in the lowest quartile (P = .02); the same directional relationship was observed for readmission intervals from 1 to 365 days after discharge.
Conclusions |
Hospital readmission rates are significantly related to the performance of the surrounding health care system.
Le texte complet de cet article est disponible en PDF.Mots-clés : ACSC, AOR, APR-DRG, CCC, PHIS
Plan
| Supported in part by the National Institute of Child Health and Human Development (K23 HD047655 to S.P.), the General Clinical Research Centers Program of National Center for Research Resources at the National Institute of Health (MO1 RR00069 to M.K.), the National Institute of Allergy and Infectious Diseases (K01 AI73729), and the Robert Wood Johnson Foundation Physician Faculty Scholars Program (S.S.). These supporters had no role in the design and conduct of the study, the collection, analysis, and interpretation of the data, or the preparation, review, and approval of the manuscript. The authors declare no conflicts of interest. |
Vol 157 - N° 1
P. 98 - juillet 2010 Retour au numéro
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