title: Predictors of 30-day readmission and association with primary care follow-up plans.
abstract: OBJECTIVE
  To test the hypothesis that missing primary care follow-up plans in the discharge summary is associated with higher 30-day readmissions.
  
  
  METHODS
  This retrospective cohort study included pediatric patients discharged from Mattel Children's Hospital, University of California, Los Angeles between July 2008 and July 2010. Exclusions included deaths, transfers, neonatal discharges, stays under 24 hours, and patients over 18 years of age. Bivariate and propensity weighted multivariate logistic regressions tested relationships between 30-day readmission and patient demographics, illness severity, and documentation of primary care provider (PCP) follow-up plans at discharge.
  
  
  RESULTS
  There were 7794 index discharges (representing 5056 unique patients), with 1457 readmissions within 30 days (18.7%). Average length of stay was 6.3 days. Being 15-18 years old, (OR 1.42 [1.02-1.96]), having public insurance (OR 1.48 [1.20-1.83]), or having higher All-Patient Refined Diagnosis-Related Group severity scores (for severity = 4 vs 1, OR 6.88 [4.99-9.49]) was associated with increased odds of 30-day readmission. After adjusting for insurance status, Asian (OR 1.46 [1.01-2.12]) but not Black or Hispanic, race/ethnicity was associated with greater odds of readmission. Fifteen percent of 172 medical records from a randomly selected month in 2010 documented PCP follow-up plans. After adjusting for demographics, length of stay and severity, documenting PCP follow-up plans was associated with significantly increased odds of 30-day readmission (OR 4.52 [1.01-20.31]).
  
  
  CONCLUSIONS
  Readmission rates are complex quality measures, and documenting primary care follow-up may be associated with higher rather than lower 30-day readmissions. Additional studies are needed to understand the inpatient-outpatient transition.
authors.affiliation: Department of Pediatrics, David Geffen School of Medicine, Mattel Children's Hospital, University of California, Los Angeles, Los Angeles, CA. Electronic address: rcoller@mednet.ucla.edu.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Coller
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Lerner
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: APR-DRG; AUC; All-Patient Refined Diagnosis-Related Group; Area under the curve; LOS; Length of stay; PCP; Primary care provider