title: Measuring pediatric hospital readmission rates to drive quality improvement.
abstract: The Pediatric Quality Measures Program is developing readmission measures for pediatric use. We sought to describe the importance of readmissions in children and the challenges of developing readmission quality measures. We consider findings and perspectives from research studies and commentaries in the pediatric and adult literature, characterizing arguments for and against using readmission rates as measures of pediatric quality and discussing available evidence and current knowledge gaps. The major topic of debate regarding readmission rates as pediatric quality measures is the relative influence of hospital quality versus other factors within and outside of health systems on readmission risk. The complex causation of readmissions leads to disagreement, particularly when rates are publicly reported or tied to payment, about whether readmissions can be prevented and how to achieve fair comparisons of readmission performance. Despite these controversies, the policy focus on readmissions has motivated widespread efforts by hospitals and outpatient providers to evaluate and reengineer care processes. Many adult studies demonstrate a link between successful initiatives to improve quality and reductions in readmissions. More research is needed on methods to enhance adjustment of readmission rates and on how to prevent pediatric readmissions.
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass. Electronic address: mari.nakamura@childrens.harvard.edu.
authors.forename: Mari M
authors.initials: MM
authors.lastname: Nakamura
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Sara L
authors.initials: SL
authors.lastname: Toomey
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Mass.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pa; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pa.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Lorch
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass; Division of General Medicine, Brigham and Women's Hospital, Boston, Mass; Veterans Affairs Boston Healthcare System, Boston, Mass.
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Bryant
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Alexandra T
authors.initials: AT
authors.lastname: Geanacopoulos
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Loren
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Debanjan
authors.initials: D
authors.lastname: Pain
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D014481:United States
keywords: pediatrics; quality measurement; readmissions