Contribution of recurrent admissions in children and young people to emergency hospital admissions: retrospective cohort analysis of hospital episode statistics

Wijlaars, Linda; Hardelid, Pia; Woodman, Jenny; Allister, Janice; Cheung, Ronny; Gilbert, Ruth

doi:10.1136/archdischild-2014-307771

Cited by 15 publications

(18 citation statements)

References 11 publications

(19 reference statements)

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“…For details on how we defined admissions, see online supplementary appendix B and previous reports 1 14…”

Section: Methodsmentioning

confidence: 99%

“…The primary diagnosis is determined and entered by professional NHS coders after discharge and is defined as the main condition treated or investigated during the relevant episode of healthcare 19. For statistical analysis, we defined six broad groups of International Classification of Diseases, version 10 (ICD-10) diagnostic codes recorded in the primary diagnosis: infection,20 chronic condition,14 injury,21 pregnancy related or perinatal related,1 sign or symptom (ICD-10 chapter 18) or other for all residual diagnoses. To determine the impact of the grouping of codes, we also grouped the primary diagnosis by 23 ICD-10 chapters (codes for groupings are listed in online supplementary appendix B).…”

Section: Methodsmentioning

confidence: 99%

“…A large proportion (32%) of children and young people (CYP) who have an emergency hospital admission will have at least one further emergency admission during the next 2 years 1. One in four of these patients are readmitted within 30 days of discharge.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Who comes back with what: a retrospective database study on reasons for emergency readmission to hospital in children and young people in England

Wijlaars¹,

Hardelid

Woodman

et al. 2016

Arch Dis Child

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“…For details on how we defined admissions, see online supplementary appendix B and previous reports 1 14…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Who comes back with what: a retrospective database study on reasons for emergency readmission to hospital in children and young people in England

Wijlaars¹,

Hardelid

Woodman

et al. 2016

Arch Dis Child

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“…The timing used for this metric has fallen under question [3,4,5] and the metric itself does not consistently correlate with adherence to quality indicators [6,7] or low inpatient mortality rates, [8,9,10]; rather it seems more closely associated with idiosyncratic factors such as hospital volume [7,11]. On a patient level, 30-day readmissions disproportionately affect patients with higher chronic illness burden [12–14], and lower socioeconomic status [15–20], rather than representing factors directly related to the index hospitalization, such as physician cognitive errors or problematic systems of care. Hospitals caring for the most socially and medically vulnerable patient populations face the highest penalties as a result [21]; leading to increasing concerns that readmission penalties may exacerbate healthcare disparities.…”

Section: Introductionmentioning

confidence: 99%

Preventability of early vs. late readmissions in an academic medical center

et al. 2017

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BackgroundIt is unclear if the 30-day unplanned hospital readmission rate is a plausible accountability metric.ObjectiveCompare preventability of hospital readmissions, between an early period [0–7 days post-discharge] and a late period [8–30 days post-discharge]. Compare causes of readmission, and frequency of markers of clinical instability 24h prior to discharge between early and late readmissions.Design, setting, patients120 patient readmissions in an academic medical center between 1/1/2009-12/31/2010MeasuresSum-score based on a standard algorithm that assesses preventability of each readmission based on blinded hospitalist review; average causation score for seven types of adverse events; rates of markers of clinical instability within 24h prior to discharge.ResultsReadmissions were significantly more preventable in the early compared to the late period [median preventability sum score 8.5 vs. 8.0, p = 0.03]. There were significantly more management errors as causative events for the readmission in the early compared to the late period [mean causation score [scale 1–6, 6 most causal] 2.0 vs. 1.5, p = 0.04], and these errors were significantly more preventable in the early compared to the late period [mean preventability score 1.9 vs 1.5, p = 0.03]. Patients readmitted in the early period were significantly more likely to have mental status changes documented 24h prior to hospital discharge than patients readmitted in the late period [12% vs. 0%, p = 0.01].ConclusionsReadmissions occurring in the early period were significantly more preventable. Early readmissions were associated with more management errors, and mental status changes 24h prior to discharge. Seven-day readmissions may be a better accountability measure.

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“…Differentiating between health status and illness severity is challenging given a lack of reliable indicators in routine data. In a UHC system, consultations with GPs are not a good proxy for poor health status since preventive advice or disease management for ACS chronic conditions can be given during a consultation; this is highlighted by the fact that illness consultations modify the effect of having an ACS chronic condition on unplanned hospital admissions [ 35 ]. Hence, this is among a number of sources of residual confounding that we were unable to account for.…”

Section: Discussionmentioning

confidence: 99%

Impact of preventive primary care on children’s unplanned hospital admissions: a population-based birth cohort study of UK children 2000–2013

Cecil

Bottle

Richard

et al. 2018

BMC Med

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BackgroundUniversal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC.MethodsWe followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not.ResultsOverall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1–4 years) and primary school (5–9 years) children, respectively.Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79–2.00) and vaccine-preventable admissions (HR 4.41, 2.59–7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55–4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17–1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77–2.04, HR 11.43, 8.48–15.39, and HR 4.82, 3.93–5.91, respectively). These associations were modified in children who consulted more in primary care.ConclusionsA high uptake of preventive primary care from birth is associated with fewer unplanned and ACS admissions in children. However, the clustering of poor health, a lack of preventive care uptake, and social deprivation puts some children with comorbid conditions at very high risk of admission. Strengthening immunisation coverage and preventive primary care in countries with poor UHC could potentially significantly reduce the health burden from hospital admission in children.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1142-3) contains supplementary material, which is available to authorized users.

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Contribution of recurrent admissions in children and young people to emergency hospital admissions: retrospective cohort analysis of hospital episode statistics

Cited by 15 publications

References 11 publications

Who comes back with what: a retrospective database study on reasons for emergency readmission to hospital in children and young people in England

Who comes back with what: a retrospective database study on reasons for emergency readmission to hospital in children and young people in England

Preventability of early vs. late readmissions in an academic medical center

Impact of preventive primary care on children’s unplanned hospital admissions: a population-based birth cohort study of UK children 2000–2013

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