Hospital readmission in children with complex chronic conditions discharged from subacute care.
OBJECTIVE
Children with complex chronic conditions (CCC) are responsible for a disproportionate number of hospital readmissions. This study sought to determine 30-day hospital readmission rates in children with CCC discharged from a rehabilitation and transitional care hospital and to identify factors associated with increased risk of readmission.


METHODS
We conducted a retrospective cohort study identifying children with CCC discharged over an 18-month period from a subacute care facility staffed by hospitalists from a freestanding children's hospital. The primary outcome measure was readmission to the referring acute care hospital within 30 days of the subacute discharge.


RESULTS
Of the 272 discharged patients meeting inclusion criteria as children with at least 1 CCC, 19% had at least 1 readmission within 30 days of discharge. On univariate analysis, readmission was associated with the number of home medications (P = .001), underlying chronic respiratory illness (P < .001), home apnea or pulse oximetry monitor use (P = .02), tracheostomy and/or ventilator dependence (P = .003), length of stay (P = .04), and number of follow-up appointments (P = .02). On multivariate analysis, the number of discharge medications was associated with increased odds of readmission (odds ratio: 1.11 [95% confidence interval: 1.03-1.20]; P = .01). Receiver operating curve analysis identified a cutoff of 8 medications as most associated with readmission; in patients discharged with ≥8 medications, the hospital readmission rate was 29%.


CONCLUSIONS
This is the first known study that investigated hospital readmission rates in children with CCC discharged from a subacute facility and specifically identified the number of discharge medications as a significant risk factor for readmission.
Divisions of Hospital Medicine, and.
Valerie
V
Jurgens
Michael C
MC
Spaeder
Padmaja
P
Pavuluri
Zev
Z
Waldman
D002648:Child; D002908:Chronic Disease / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019338:Polypharmacy; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D019467:Subacute Care
children with medical complexity; complex chronic conditions; health care utilization; hospital readmission; subacute facility