title: Rates and impact of potentially preventable readmissions at children's hospitals.
abstract: OBJECTIVE
  To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals.
  
  
  METHODS
  A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions.
  
  
  RESULTS
  The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year).
  
  
  CONCLUSIONS
  Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN. Electronic address: james.gay@vanderbilt.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Gay
authors.affiliation: Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.affiliation: Seattle Children's Hospital, Seattle, WA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Del Beccaro
authors.affiliation: Washington University in St. Louis, St. Louis, MO.
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.affiliation: National Church Residences, Columbus, OH.
authors.forename: Justin
authors.initials: J
authors.lastname: Golias
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hain
authors.affiliation: Nationwide Children's Hospital, Columbus, OH.
authors.forename: Richard
authors.initials: R
authors.lastname: McClead
authors.affiliation: Children's Medical Center, Dallas, TX.
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.affiliation: Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Javier
authors.initials: J
authors.lastname: Tejedor-Sojo
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Teufel
authors.affiliation: Children's Hospital Association, Alexandria, VA.
authors.forename: J Mitchell
authors.initials: JM
authors.lastname: Harris
authors.affiliation: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011159:Population Surveillance / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D014068:Tonsillectomy