title: An Examination of Physician-, Caregiver-, and Disease-Related Factors Associated With Readmission From a Pediatric Hospital Medicine Service.
abstract: OBJECTIVE
  The purpose of this study was to describe the characteristics and reasons for pediatric hospital medicine readmissions. We also aimed to describe characteristics of potentially preventable cases and the reliability of classification.
  
  
  METHODS
  Retrospective descriptive study from December 2008 through June 2010 in a large academic tertiary care children's hospital in Houston, Texas. Children were included if they were readmitted to the hospital within 30 days of discharge from the pediatric hospital medicine service. Reasons for readmission were grouped into three categories: physician-related, caretaker-related, and disease-related. Readmissions with physician- or caretaker-related reasons were considered potentially preventable.
  
  
  RESULTS
  The overall readmission rate was 3.1%, and a total of 204 subjects were included in the analysis. Lymphadenitis and failure to thrive had the highest readmission rates with 21%, and 13%, respectively. Twenty percent (n=41/204) of readmissions were preventable with 24% (n=10/41) being physician-related, 12% (n=5/41) caregiver-related, and 63% (n=26/41) for mixed reasons. When comparing classification of readmissions into preventable status, there was moderate agreement between 2 reviewers (K=0.44, 95% confidence interval: 0.28-0.60). Among patients with preventable readmission, the probability of having had a readmission by 7 days and 15 days was 73% and 78%, respectively.
  
  
  CONCLUSIONS
  Reliable identification of preventable pediatric readmissions using individual reviewers remains a challenge. Additional studies are needed to develop a reliable approach to identify preventable readmissions and underlying modifiable factors. A focused review of 7-day readmissions and diagnoses with high readmission rates may allow use of fewer resources.
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas; sswallac@texaschildrens.org.
authors.forename: Sowdhamini S
authors.initials: SS
authors.lastname: Wallace
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, Texas; and.
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Keller
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas;
authors.forename: Carla N
authors.initials: CN
authors.lastname: Falco
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas;
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Nead
authors.affiliation: Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas.
authors.forename: Charles G
authors.initials: CG
authors.lastname: Minard
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas;
authors.forename: Pratip K
authors.initials: PK
authors.lastname: Nag
authors.affiliation: Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, Texas; and.
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Quinonez
mesh_terms: D000293:Adolescent; D000359:Aftercare; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003142:Communication; D003951:Diagnostic Errors; D018450:Disease Progression; D005183:Failure to Thrive; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008199:Lymphadenitis; D008297:Male; D055118:Medication Adherence; D010359:Patient Readmission / Q000706:statistics & numerical data*; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies