title: Children's Hospital Characteristics and Readmission Metrics.
abstract: OBJECTIVE
  Like their adult counterparts, pediatric hospitals are increasingly at risk for financial penalties based on readmissions. Limited information is available on how the composition of a hospital's patient population affects performance on this metric and hence affects reimbursement for hospitals providing pediatric care. We sought to determine whether applying different readmission metrics differentially affects hospital performance based on the characteristics of patients a hospital serves.
  
  
  METHODS
  We performed a cross-sectional analysis of 64 children's hospitals from the Children's Hospital Association Case Mix Comparative Database 2012 and 2013. We calculated 30-day observed-to-expected readmission ratios by using both all-cause (AC) and Potentially Preventable Readmissions (PPR) metrics. We examined the association between observed-to-expected rates and hospital characteristics by using multivariable linear regression.
  
  
  RESULTS
  We examined a total of 1 416 716 hospitalizations. The mean AC 30-day readmission rate was 11.3% (range 4.3%-19.6%); the mean PPR rate was 4.9% (range 2.9%-6.9%). The average 30-day AC observed-to-expected ratio was 0.96 (range 0.63-1.23), compared with 0.95 (range 0.65-1.23) for PPR; 59% of hospitals performed better than expected on both measures. Hospitals with higher volumes, lower percentages of infants, and higher percentage of patients with low income performed worse than expected on PPR.
  
  
  CONCLUSIONS
  High-volume hospitals, those that serve fewer infants, and those with a high percentage of patients from low-income neighborhoods have higher than expected PPR rates and are at higher risk of reimbursement penalties.
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; katherine.auger@cchmc.org.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Auger
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Teufel
authors.affiliation: Children's Hospital Association, Washington, District of Columbia.
authors.forename: J Mitchell
authors.initials: JM
authors.lastname: Harris
authors.affiliation: Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: James C
authors.initials: JC
authors.lastname: Gay
authors.affiliation: Seattle Children's Hospital and Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Del Beccaro
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
authors.forename: Javier
authors.initials: J
authors.lastname: Tejedor-Sojo
authors.affiliation: Department of Pediatrics, Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois.
authors.forename: Rishi K
authors.initials: RK
authors.lastname: Agrawal
authors.affiliation: Children's Health System of Texas and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Rustin B
authors.initials: RB
authors.lastname: Morse
authors.affiliation: Pediatric Cardiothoracic Surgery, Washington University in St Louis, St Louis, Missouri.
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.affiliation: Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.|Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Harold K
authors.initials: HK
authors.lastname: Simon
authors.affiliation: Office of the Chief Medical Officer, Nationwide Children's Hospital, Columbus, Ohio; and.
authors.forename: Richard E
authors.initials: RE
authors.lastname: McClead
authors.affiliation: Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Fieldston
authors.affiliation: Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D003430:Cross-Sectional Studies; D061847:Hospitals, High-Volume; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015999:Multivariate Analysis; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011203:Poverty; D019984:Quality Indicators, Health Care; D064890:Social Determinants of Health; D014481:United States