title: Pediatric Inpatient Readmissions in an Accountable Care Organization.
abstract: OBJECTIVE
  To assess the association between the length of consistent primary care as part of an accountable care organization (attribution length) and population-level and same-hospital readmissions. Readmission studies are generally focused on same-hospital readmissions rather than readmissions to any hospital (population-level readmissions).
  
  
  METHODS
  A retrospective study of Medicaid claims data for 28,794 unique pediatric patients attributed to a single children's hospital between September 2013 and May 2015. Study used logistic regression to estimate the impact of attribution length on readmissions and a zero-inflated Poisson model to assess the impact of attribution length on readmission cost and readmission days.
  
  
  RESULTS
  The study showed attribution length was associated with a significant reduction in the population-level 30-day readmission rate from 8.9%-6.2% (P = .010) primarily by reducing readmissions that occurred at hospitals other than the discharging hospital. There was no significant reduction in the same-hospital readmission rate. Readmissions to a different hospital occurred in 37% of readmissions. Although not significant at the P = .05 level, attribution length was associated with a 44% reduction (P = .100) in 30-day readmission costs or a 5.0% reduction in the cost of an inpatient episode of care and a 53% reduction (P = .019) in readmission days.
  
  
  CONCLUSIONS
  Consistent primary care (attribution length) may be able to reduce 30-day, pediatric Medicaid patients' readmissions at the population level. The decrease occurred primarily in readmissions to hospitals other than the discharging hospital. There was no decrease in the rate of same-hospital readmissions.
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN. Electronic address: eric.christensen@childrensmn.org.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Christensen
authors.affiliation: Department of Research and Sponsored Programs, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN; Department of Quality and Safety, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.
authors.forename: Nathaniel R
authors.initials: NR
authors.lastname: Payne
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D010359:Patient Readmission / Q000191:economics* / Q000706:statistics & numerical data; D011320:Primary Health Care; D012189:Retrospective Studies; D014481:United States