The role of outpatient facilities in explaining variations in risk-adjusted readmission rates between hospitals.
OBJECTIVE
Validate risk-adjusted readmission rates as a measure of inpatient quality of care after accounting for outpatient facilities, using premature infants as a test case.


METHODS
Surviving infants born between January 1, 1998 and December 12, 2001 at five Northern California Kaiser Permanente neonatal intensive care units (NICU) with 1-year follow-up at 32 outpatient facilities.


METHODS
Using a retrospective cohort of premature infants (N=898), Poisson's regression models determined the risk-adjusted variation in unplanned readmissions between 0-1 month, 0-3 months, 3-6 months, and 3-12 months after discharge attributable to patient factors, NICUs, and outpatient facilities.


METHODS
Prospectively collected maternal and infant hospital data were linked to inpatient, outpatient, and pharmacy databases.


RESULTS
Medical and sociodemographic factors explained the largest amount of variation in risk-adjusted readmission rates. NICU facilities were significantly associated with readmission rates up to 1 year after discharge, but the outpatient facility where patients received outpatient care can explain much of this variation. Characteristics of outpatient facilities, not the NICUs, were associated with variations in readmission rates.


CONCLUSIONS
Ignoring outpatient facilities leads to an overstatement of the effect of NICUs on readmissions and ignores a significant cause of variations in readmissions.
Department of Pediatrics, Center for Outcomes Research, The Children's Hospital of Philadelphia, The University of Pennsylvania School of Medicine, Philadelphia, PA, USA. lorch@email.chop.edu
Scott A
SA
Lorch
Michael
M
Baiocchi
Jeffrey H
JH
Silber
Orit
O
Even-Shoshan
Gabriel J
GJ
Escobar
Dylan S
DS
Small
D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002140:California; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D016012:Poisson Distribution; D047928:Premature Birth; D011787:Quality of Health Care; D012189:Retrospective Studies; D020379:Risk Adjustment