title: Hospital utilization and characteristics of patients experiencing recurrent readmissions within children's hospitals.
abstract: BACKGROUND
  Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact.
  
  
  OBJECTIVE
  To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals.
  
  
  METHODS
  Retrospective cohort analysis of 317,643 patients (n = 579,504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008.
  
  
  METHODS
  Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period.
  
  
  RESULTS
  In the sample, 69,294 patients (21.8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2.9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range [IQR], 21-63). These patients accounted for 18.8% (109,155 admissions) of all admissions and 23.2% ($3.4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22.3% [n = 55,382/248,349] to 89.0% [n = 8225/9237]; P < .001), technology assistance (from 5.3% [n = 13,163] to 52.6% [n = 4859]; P < .001), public insurance use (from 40.9% [n = 101,575] to 56.3% [n = 5202]; P < .001), and non-Hispanic black race (from 21.8% [n = 54,140] to 34.4% [n = 3181]; P < .001); and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23.1% [62,847/272,065] to 14.0% [15,282/109,155], P < .001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28.5%) were rehospitalized for a problem in the same organ system across all admissions during the interval.
  
  
  CONCLUSIONS
  Among a group of pediatric hospitals, 18.8% of admissions and 23.2% of inpatient charges were accounted for by the 2.9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.
authors.affiliation: Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: David E
authors.initials: DE
authors.lastname: Hall
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.forename: Chris
authors.initials: C
authors.lastname: Feudtner
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kueser
authors.forename: William
authors.initials: W
authors.lastname: Kaplan
authors.forename: John
authors.initials: J
authors.lastname: Neff
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002908:Chronic Disease; D015331:Cohort Studies; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006295:Health Resources / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage; D038801:International Classification of Diseases; D013677:Medical Laboratory Science / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015995:Prevalence; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult