title: Pediatric readmission prevalence and variability across hospitals.
abstract: OBJECTIVE
  Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge.
  
  
  OBJECTIVE
  To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals.
  
  
  METHODS
  We analyzed 568,845 admissions at 72 children's hospitals between July 1, 2009, and June 30, 2010, in the National Association of Children's Hospitals and Related Institutions Case Mix Comparative data set. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and Chronic Condition Indicators. Hospitals with adjusted readmission rates that were 1 SD above and below the mean were defined as having "high" and "low" rates, respectively.
  
  
  METHODS
  Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification.
  
  
  RESULTS
  The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n = 36,734). Adjusted rates were 28.6% greater in hospitals with high vs low readmission rates (7.2% [95% CI, 7.1%-7.2%] vs 5.6% [95% CI, 5.6%-5.6%]). For the 10 admission diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs low readmission rates. For example, sickle cell rates were 20.1% (95% CI, 20.0%-20.3%) vs 12.7% (95% CI, 12.6%-12.8%) in high vs low hospitals, respectively.
  
  
  CONCLUSIONS
  Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was significant variability in readmission rates across conditions and hospitals. These data may be useful for hospitals' quality improvement efforts.
authors: Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA. jay.berry@childrens.harvard.edu
authors: Jay G
authors: JG
authors: Berry
authors: Sara L
authors: SL
authors: Toomey
authors: Alan M
authors: AM
authors: Zaslavsky
authors: Ashish K
authors: AK
authors: Jha
authors: Mari M
authors: MM
authors: Nakamura
authors: David J
authors: DJ
authors: Klein
authors: Jeremy Y
authors: JY
authors: Feng
authors: Shanna
authors: S
authors: Shulman
authors: Vincent W
authors: VW
authors: Chiang
authors: Vincent K
authors: VK
authors: Chiang
authors: William
authors: W
authors: Kaplan
authors: Matt
authors: M
authors: Hall
authors: Mark A
authors: MA
authors: Schuster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003953:Diagnosis-Related Groups; D005260:Female; D006776:Hospitals, Pediatric / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States