title: Measuring hospital quality using pediatric readmission and revisit rates.
abstract: OBJECTIVE
  To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals.
  
  
  METHODS
  In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.
  
  
  RESULTS
  Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%).
  
  
  CONCLUSIONS
  We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.
authors: Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. bardachn@peds.ucsf.edu
authors: Naomi S
authors: NS
authors: Bardach
authors: Eric
authors: E
authors: Vittinghoff
authors: Renée
authors: R
authors: Asteria-Peñaloza
authors: Jeffrey D
authors: JD
authors: Edwards
authors: Jinoos
authors: J
authors: Yazdany
authors: Henry C
authors: HC
authors: Lee
authors: W John
authors: WJ
authors: Boscardin
authors: Michael D
authors: MD
authors: Cabana
authors: R Adams
authors: RA
authors: Dudley
mesh_terms: D000293:Adolescent; D001064:Appendicitis / Q000453:epidemiology / Q000628:therapy; D001249:Asthma / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003681:Dehydration / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004827:Epilepsy / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006276:Health Facility Size / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D019964:Mood Disorders / Q000453:epidemiology / Q000628:therapy; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000453:epidemiology / Q000628:therapy; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D017192:Skin Diseases, Bacterial / Q000453:epidemiology / Q000628:therapy; D014481:United States; D014600:Utilization Review; D055815:Young Adult
keywords: child health research; delivery of care; health policy; hospital performance variation; quality measurement; readmission rates
references: Pediatrics. 2013 Jan;131(1):e171-81
references: 23230064
references: Arch Pediatr Adolesc Med. 2011 May;165(5):429-34
references: 21536958
references: Pediatrics. 2012 Sep;130(3):482-91
references: 22908110
references: Pediatrics. 2001 Jun;107(6):E99
references: 11389297
references: Pediatrics. 2004 Oct;114(4):e400-8
references: 15466064
references: JAMA. 2011 Oct 5;306(13):1454-60
references: 21972307
references: Implement Sci. 2009 May 08;4:25
references: 19426507
references: JAMA. 2013 Jan 23;309(4):372-80
references: 23340639
references: Pediatrics. 2009 Jan;123(1):286-93
references: 19117894
references: Am Heart J. 2008 Mar;155(3):577-84
references: 18294499
references: Arch Intern Med. 2006 Sep 25;166(17):1822-8
references: 17000937
references: Pediatrics. 2012 Nov;130(5):e823-30
references: 23090342
references: Acad Pediatr. 2010 Jul-Aug;10(4):266-73
references: 20599180
references: Acad Pediatr. 2011 May-Jun;11(3 Suppl):S1-S10
references: 21570012
references: Pediatrics. 2011 Jul;128(1):182-200
references: 21708806
references: Curr Opin Obstet Gynecol. 2009 Dec;21(6):532-40
references: 19797948
references: J Pediatr Surg. 2012 Jun;47(6):1170-6
references: 22703789
references: Pediatr Infect Dis J. 2012 Oct;31(10):1036-41
references: 22653486
references: Crit Care Med. 2012 Jul;40(7):2196-203
references: 22564961
references: J Am Pharm Assoc (2003). 2012 May-Jun;52(3):358-62
references: 22618976
references: Clin Pediatr (Phila). 2005 Jul-Aug;44(6):509-13
references: 16015398
references: Health Serv Res. 2010 Feb;45(1):24-41
references: 19780853
references: JAMA. 2011 Feb 16;305(7):682-90
references: 21325184
references: J Pediatr. 2005 Nov;147(5):622-6
references: 16291352
references: Pediatrics. 2011 Mar;127(3):529-38
references: 21339266