Length of Stay and Cost of Pediatric Readmissions

Markham, Jessica L.; Hall, Matt; Gay, James C.; Bettenhausen, Jessica L.; Berry, Jay G.

doi:10.1542/peds.2017-2934

Cited by 60 publications

(32 citation statements)

References 18 publications

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“…Because the user does not have access to patient records or clinical outcomes, there is no way to formally validate the information extracted with actual patient data. Nonetheless, the NRD has been extensively employed throughout the literature as a tool for exploring readmission trends across a wide range of subspecialties 45–49 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of Surgical Site Infection After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

et al. 2018

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SSI incidence in neurosurgery is low and most readmissions occur within 30 days. Several factors predicted SSI after craniotomy, including operations for tumor, younger age, hospitalization length, diabetes, discharge to institutional care, larger hospital bed size, Medicaid insurance, and presence of an EVD. Diabetes and EVD placement may represent modifiable factors that could be explored in subsequent prospective studies for their associations with cranial SSIs.

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Section: Discussionmentioning

confidence: 99%

Predictors of Surgical Site Infection After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

et al. 2018

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“…28,29 Although data regarding total Medicaid expenditures on pediatric readmissions are not readily available, readmissions for Medicaid beneficiaries cost ∼$1000 more on average than those for privately insured patients, and episodes of care that result in readmissions are 2.3 times more expensive than those without readmissions. 13,30 There are several potential explanations for the higher readmission rates observed in Medicaid-insured patients who may shed light on strategies for eliminating this disparity. Consistent with previous studies, we found that patients insured by Medicaid had more chronic or complex conditions than those insured by private insurers.…”

Section: Figurementioning

confidence: 99%

Trends in 30-Day Readmission for Medicaid and Privately Insured Pediatric Patients: 2010–2017

2020

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BACKGROUND: Children insured by Medicaid have higher readmission rates than privately insured children. However, little is known about whether this disparity has changed over time.METHODS: Data from the 2010 to 2017 Healthcare Cost and Utilization Project Nationwide Readmissions Database were used to compare trends in 30-day readmission rates for children insured by Medicaid and private insurers. Patient-level crude and risk-adjusted readmission rates were compared by using Poisson regression. Hospital-level risk-adjusted readmission rates were compared between Medicaid-and privately insured patients within a hospital by using linear regression.RESULTS: Approximately 60% of pediatric admissions were covered by Medicaid. From 2010 to 2017, the percentage of children with a complex or chronic condition increased for both Medicaid-and privately insured patients. Readmission rates were consistently higher for Medicaid beneficiaries from 2010 to 2017. Readmission rates declined slightly for both Medicaid-and privately insured patients; however, they declined faster for privately insured patients (rate ratio: 0.988 [95% confidence interval: 0.986-0.989] vs 0.995 [95% confidence interval: 0.994-0.996], P for interaction ,.001]). After adjustment, readmission rates for Medicaid-and privately insured patients declined at a similar rate (P for interaction = .87). Risk-adjusted hospital readmission rates were also consistently higher for Medicaid beneficiaries. The within-hospital difference in readmission rates for Medicaid versus privately insured patients remained stable over time (slope for difference: 0.015 [SE 0.011], P = .019). CONCLUSIONS:Readmission rates for Medicaid-and privately insured pediatric patients declined slightly from 2010 to 2017 but remained substantially higher among Medicaid beneficiaries suggesting a persistence of the disparity by insurance status.WHAT'S KNOWN ON THIS SUBJECT: Historically, 30-day readmission rates have been higher for Medicaid-versus privately insured pediatric patients. Recent efforts to reduce readmissions in pediatric patients may have reduced the magnitude of this disparity over time.

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“…The definition of rehospitalization varies across studies. The most commonly used definition of rehospitalization is rehospitalization between 28 and 31 days after discharge for unplanned reasons (4)(5)(6)(7)(8). Rehospitalization rates for children aged 0-18 years range from 3.4-28.6% (5,(9)(10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Derivation and validation of a prediction model for neonate unplanned rehospitalization in a tertiary center in China

Tsai¹,

Qian²,

Lu³

et al. 2021

Transl Pediatr

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Background: To construct and externally validate a prediction model for neonate unplanned rehospitalization within 31 days of discharge.Methods: A retrospective study was performed in the Department of Neonatology of the Children's Hospital of Fudan University. A binominal regression method was applied to construct and validate the prediction model. Analysis was performed on a total of 11,116 neonates with an index admission between 11/1/2016 and 12/31/2018. Neonates admitted from 11/1/2016 to 1/31/2018 were used for the selection of prognostic variables and construction of the model. Model validation was then performed with neonates admitted from 2/1/2018 to 12/31/2018. Results:The rehospitalization rate for neonates was 3.27% (373/11,116). A total of 512 neonates were enrolled for the construction of the prediction model. Gestational age (GA), NICU length of stay (LOS), nonmedical order discharge and younger maternal age were strongly correlated with rehospitalization.By incorporating these 4 strong risk factors, we constructed a model to predict neonate unplanned rehospitalization within 31 days of discharge. The formula was turned into a nomogram for use in clinical practice. The nomogram has a total score of 180, with a predicted risk from 0 to 100%. Neonates are at high risk for rehospitalization if they have a total score greater than 39 points, according to the cutoff point established by the Youden index. The model was shown to have good discriminatory ability, with area under the receiver operating characteristic curves of 0.68 and 0.65 in the model construction and validation datasets, respectively. A total of 39 points is the cutoff for follow-up. Conclusions:The model is able to predict neonate unplanned rehospitalization well. A total score greater than 39 indicates that follow-up is necessary.

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Length of Stay and Cost of Pediatric Readmissions

Cited by 60 publications

References 18 publications

Predictors of Surgical Site Infection After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

Predictors of Surgical Site Infection After Nonemergent Craniotomy: A Nationwide Readmission Database Analysis

Trends in 30-Day Readmission for Medicaid and Privately Insured Pediatric Patients: 2010–2017

Derivation and validation of a prediction model for neonate unplanned rehospitalization in a tertiary center in China

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