Understanding predictors of postdischarge deaths: a prospective evaluation of children 5 years and younger discharged from Philippine district hospitals.
BACKGROUND
Factors that increase likelihood of readmission or mortality postdischarge from diarrhea and pneumonia cases among children is less understood.


METHODS
This study investigated the deaths of 24 children from a cohort of 3275. Using logistic regression, the authors compared data from those who survived with those who died to estimate the determinants of mortality in the study population. The authors also analyzed the hospital charts and completed mortality interviews with families of the deceased children.


RESULTS
Poor quality of care significantly increased the likelihood of mortality. Sicker children, those born to less-educated mothers, and those who had longer lengths of stay also had a higher likelihood of mortality. Hospital charts corroborated findings from clinical vignettes. The mortality interviews revealed delays in seeking care from onset of symptoms.


CONCLUSIONS
Quality of care contributes to postdischarge mortality and that clinical vignettes are an effective means to identify where quality can be improved.
Panelo
Carlo Irwin A
CI
College of Medicine, University of the Philippines, Manila, Philippines.
Shimkhada
Riti
R
Solon
Orville C
OC
Quimbo
Stella A
SA
Florentino
Jhiedon F
JF
Peabody
John W
JW
D002675:Child, Preschool; D003967:Diarrhea / Q000401:mortality* / Q000628:therapy; D004522:Educational Status; D005500:Follow-Up Studies; D006767:Hospitals, District; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D010351:Patient Discharge; D010679:Philippines / Q000453:epidemiology; D011014:Pneumonia / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies; D011787:Quality of Health Care; D012307:Risk Factors; D016896:Treatment Outcome