title: A Validated Method for Identifying Unplanned Pediatric Readmission.
abstract: OBJECTIVE
  To validate the accuracy of pre-encounter hospital designation as a novel way to identify unplanned pediatric readmissions and describe the most common diagnoses for unplanned readmissions among children.
  
  
  METHODS
  We examined all hospital discharges from 2 tertiary care children's hospitals excluding deaths, normal newborn discharges, transfers to other institutions, and discharges to hospice. We performed blinded medical record review on 641 randomly selected readmissions to validate the pre-encounter planned/unplanned hospital designation. We identified the most common discharge diagnoses associated with subsequent 30-day unplanned readmissions.
  
  
  RESULTS
  Among 166,994 discharges (hospital A: n = 55,383; hospital B: n = 111,611), the 30-day unplanned readmission rate was 10.3% (hospital A) and 8.7% (hospital B). The hospital designation of "unplanned" was correct in 98% (hospital A) and 96% (hospital B) of readmissions; the designation of "planned" was correct in 86% (hospital A) and 85% (hospital B) of readmissions. The most common discharge diagnoses for which unplanned 30-day readmissions occurred were oncologic conditions (up to 38%) and nonhypertensive congestive heart failure (about 25%), across both institutions.
  
  
  CONCLUSIONS
  Unplanned readmission rates for pediatrics, using a validated, accurate, pre-encounter designation of "unplanned," are higher than previously estimated. For some pediatric conditions, unplanned readmission rates are as high as readmission rates reported for adult conditions. Anticipating unplanned readmissions for high-frequency diagnostic groups may help focus efforts to reduce the burden of readmission for families and facilities. Using timing of hospital registration in administrative records is an accurate, widely available, real-time way to distinguish unplanned vs planned pediatric readmissions.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. Electronic address: katherine.auger@cchmc.org.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.affiliation: Center for Pediatric and Adolescent Comparative Effectiveness Research, and Section of Hematology/Oncology, Department of Pediatrics, Indiana University, Indianapolis, IN.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Mueller
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI.
authors.forename: Steven H
authors.initials: SH
authors.lastname: Weinberg
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Forster
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Anita
authors.initials: A
authors.lastname: Shah
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Christine
authors.initials: C
authors.lastname: Wolski
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Grant
authors.initials: G
authors.lastname: Mussman
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Anna J
authors.initials: AJ
authors.lastname: Ipsaro
authors.affiliation: Department of Pediatrics, Department of Internal Medicine, University of Michigan Health System, University of Michigan, Ann Arbor, MI; Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI; Institute of Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000706:statistics & numerical data*; D055815:Young Adult