title: Readmissions among children previously hospitalized with pneumonia.
abstract: OBJECTIVE
  Pneumonia is a leading cause of hospitalization and readmission in children. Understanding the patient characteristics associated with pneumonia readmissions is necessary to inform interventions to reduce avoidable hospitalizations and related costs. The objective of this study was to characterize readmission rates, and identify factors and costs associated with readmission among children previously hospitalized with pneumonia.
  
  
  METHODS
  Retrospective cohort study of children hospitalized with pneumonia at the 43 hospitals included in the Pediatric Health Information System between January 1, 2008, and December 31, 2011. The primary outcome was all-cause readmission within 30 days after hospital discharge, and the secondary outcome was pneumonia-specific readmission. We used multivariable regression models to identify patient and hospital characteristics and costs associated with readmission.
  
  
  RESULTS
  A total of 82 566 children were hospitalized with pneumonia (median age, 3 years; interquartile range 1-7). Thirty-day all-cause and pneumonia-specific readmission rates were 7.7% and 3.1%, respectively. Readmission rates were higher among children <1 year of age, as well as in patients with previous hospitalizations, longer index hospitalizations, and complicated pneumonia. Children with chronic medical conditions were more likely to experience all-cause (odds ratio 3.0; 95% confidence interval 2.8-3.2) and pneumonia-specific readmission (odds ratio 1.8; 95% confidence interval 1.7-2.0) compared with children without chronic medical conditions. The median cost of a readmission ($11 344) was higher than that of an index admission ($4495; P = .01). Readmissions occurred in 8% of pneumonia hospitalizations but accounted for 16.3% of total costs for all pneumonia hospitalizations.
  
  
  CONCLUSIONS
  Readmissions are common after hospitalization for pneumonia, especially among young children and those with chronic medical conditions, and are associated with substantial costs.
authors: Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts;Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; mark.neuman@childrens.harvard.edu.
authors: Mark I
authors: MI
authors: Neuman
authors: The Children's Hospital Association, Overland Park, Kansas;
authors: Matthew
authors: M
authors: Hall
authors: Divisions of General Pediatrics, and.
authors: James C
authors: JC
authors: Gay
authors: Division of Infectious Diseases, Primary Children's Medical Center, Salt Lake City, Utah;Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah;
authors: Anne J
authors: AJ
authors: Blaschke
authors: Departments of Pediatrics, andHospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee;
authors: Derek J
authors: DJ
authors: Williams
authors: Division of Hospital Medicine, Children's National Medical Center, Washington, District of Columbia;Department of Pediatrics, George Washington University School of Medicine, Washington, District of Columbia;
authors: Kavita
authors: K
authors: Parikh
authors: Division of Infectious Diseases, Primary Children's Medical Center, Salt Lake City, Utah;Departments of Pediatrics, and.
authors: Adam L
authors: AL
authors: Hersh
authors: Division of Critical Care, Seattle Children's Hospital, Seattle, Washington;Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington;
authors: Thomas V
authors: TV
authors: Brogan
authors: Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
authors: Jeffrey S
authors: JS
authors: Gerber
authors: Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee;
authors: Carlos G
authors: CG
authors: Grijalva
authors: Divisions of Infectious Diseases and Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; andDepartment of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
authors: Samir S
authors: SS
authors: Shah
mesh_terms: D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000191:economics / Q000628:therapy*; D012189:Retrospective Studies
keywords: pneumonia; readmission