Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children's Hospital.
Preventability of 7-Day Versus 30-Day Readmissions at an Academic Children's Hospital.
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DOI：
10.1542/hpeds.2019-0124
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Austin, Jared P
中科院分区：
文献类型：
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作者：
Gardner, Tiffany A;Vaz, Louise E;Austin, Jared P
背景和提示：30天再入院率是医疗保险用于成人患者的常见质量指标。然而，儿科研究显示，再入院率较低，可预防性可能较低。因此，一些人质疑30天再入院时间框架在儿科的实用性。我们的目的是描述在1年期间出院后30天内再次入院的患者的特征，并确定在学术儿童医院儿科住院服务出院后0至7天与8至30天再次入院的可预防性。回顾性病历审查和医院管理数据用于收集医疗特征，人口统计学，以及2015年7月1日至2016年6月30日期间再次入院患者的流程级指标。所有再入院均由2名资深作者进行审查，并分配了可预防性类别。进行了亚组分析，比较了0-7天和8-30天再入院组的可预防性。进行定性专题分析认为preventable.RESULTS：1523放电发生在研究期间，49例患者，65个不同的再入院遭遇，再入院的整体30天再入院率为4.3%（65 1523）。28%（9/32）的出院后7天内再入院和12.1%（4/33）的出院后8 - 30天再入院被认为是潜在可预防的（P = 0.13）。综合来看，30天内可预防的再入院率为20%（13/65）。结论：我们确定了可预防性和再入院时间之间的可能联系。如果通过更大规模的研究证实，7天而不是30天的时间范围可能代表了再入院儿科患者更好的质量指标。
BACKGROUND AND OBJECTIVES: The 30-day readmission rate is a common quality metric used by Medicare for adult patients. However, studies in pediatrics have shown lower readmission rates and potentially less preventability. Therefore, some question the utility of the 30-day readmission time frame in pediatrics. Our objective was to describe the characteristics of patients readmitted within 30 days of discharge over a 1-year period and determine the preventability of readmissions occurring 0 to 7 vs 8 to 30 days after discharge from a pediatric hospitalist service at an academic children's hospital.METHODS: Retrospective chart review and hospital administrative data were used to gather medical characteristics, demographics, and process-level metrics for readmitted patients between July 1, 2015, and June 30, 2016. All readmissions were reviewed by 2 senior authors and assigned a preventability category. Subgroup analysis comparing preventability in 0-to-7- and 8-to-30-day readmissions groups was performed. Qualitative thematic analysis was performed on readmissions deemed preventable.RESULTS: Of 1523 discharges that occurred during the study period, 49 patients, with 65 distinct readmission encounters, were readmitted for an overall 30-day readmission rate of 4.3% (65 of 1523). Twenty-eight percent (9 of 32) of readmissions within 7 days of discharge and 12.1% (4 of 33) occurring 8 to 30 days after discharge were deemed potentially preventable (P = .13). Combined, the 30-day preventable readmission rate was 20% (13 of 65).CONCLUSIONS: We identified a possible association between preventability and time to readmission. If confirmed by larger studies, the 7-day, rather than 30-day, time frame may represent a better quality metric for readmitted pediatric patients.