Predictors of 30-Day Readmission and Association with Primary Care Follow-Up Plans

Coller, Ryan J.; Klitzner, Thomas S.; Lerner, Carlos F.; Chung, Paul J.

doi:10.1016/j.jpeds.2013.04.013

Cited by 38 publications

(46 citation statements)

References 27 publications

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“…Increasing numbers of studies demonstrate the challenges of interpreting readmission rates, 27,52,53 including poor reliability in identifying preventable readmissions. 28 To date, separation of preventable readmissions from all readmissions cannot be accomplished by using administrative data alone.…”

Section: Discussionmentioning

confidence: 99%

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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BACKGROUND AND OBJECTIVES: Children with medical complexity (CMC) account for disproportionately high hospital use, and it is unknown if hospitalizations may be prevented. Our objective was to summarize evidence from (1) studies characterizing potentially preventable hospitalizations in CMC and (2) interventions aiming to reduce such hospitalizations. METHODS:Our data sources include Medline, Cochrane Central Register of Controlled Trials, Web of Science, and Cumulative Index to Nursing and Allied Health Literature databases from their originations, and hand search of article bibliographies. Observational studies (n = 13) characterized potentially preventable hospitalizations, and experimental studies (n = 4) evaluated the efficacy of interventions to reduce them. Data were extracted on patient and family characteristics, medical complexity and preventable hospitalization indicators, hospitalization rates, costs, and days. Results of interventions were summarized by their effect on changes in hospital use. RESULTS:Preventable hospitalizations were measured in 3 ways: ambulatory care sensitive conditions, readmissions, or investigator-defined criteria. Postsurgical patients, those with neurologic disorders, and those with medical devices had higher preventable hospitalization rates, as did those with public insurance and nonwhite race/ethnicity. Passive smoke exposure, nonadherence to medications, and lack of follow-up after discharge were additional risks. Hospitalizations for ambulatory care sensitive conditions were less common in more complex patients. Patients receiving home visits, care coordination, chronic care-management, and continuity across settings had fewer preventable hospitalizations.CONCLUSIONS: There were a limited number of published studies. Measures for CMC and preventable hospitalizations were heterogeneous. Risk of bias was moderate due primarily to limited controlled experimental designs. Reductions in hospital use among CMC might be possible. Strategies should target primary drivers of preventable hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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“…Pediatric readmission research has centered primarily on hospitaloriented perspectives, using data from administrative claims, [3][4][5][6] chart reviews, [7][8][9] and quality improvement collaboratives, 1 or from studies of discharge transition practices. [10][11][12][13] Far less attention has been paid to conceptually important constructs such as overall primary care experience, caregiver activation, and broad social determinants of health.…”

Section: What This Study Addsmentioning

confidence: 99%

“…[10][11][12][13] Far less attention has been paid to conceptually important constructs such as overall primary care experience, caregiver activation, and broad social determinants of health. These limitations in readmissions research might explain some of the counterintuitive findings observed thus far 7,14,15 and why tools that predict readmissions with high sensitivity and specificity are not yet available. 5,16 For example, although a high-functioning pediatric medical home that is focused on access, coordination, and comprehensive care may be protective against such postdischarge utilization, 2,17 this question remains largely unanswered.…”

Section: What This Study Addsmentioning

confidence: 99%

The Medical Home and Hospital Readmissions

et al. 2015

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BACKGROUND AND OBJECTIVE: Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.METHODS: This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences. RESULTS:We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.CONCLUSIONS: Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge. WHAT'S KNOWN ON THIS SUBJECT:Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.WHAT THIS STUDY ADDS: Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge.

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“…Although some studies observe positive relationships between specific activities and reduced postdischarge utilization, 1 others suggest no relationship [9][10][11][12] or, paradoxically, more utilization. 13, 14 Brittan et al 15 found that outpatient visits were associated with more readmissions when occurring less than 4 days after discharge, but fewer readmissions when occurring 4 days to 29 days after discharge. Most studies, however, investigate single or limited sets of care activities, such as having an outpatient visit, 15 timeliness of that visit, 16 or receipt of a discharge summary.…”

confidence: 99%