Pediatric readmission prevalence and variability across hospitals.
Pediatric readmission prevalence and variability across hospitals.
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DOI：
10.1001/jama.2012.188351
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发表时间：
2013-01-23
影响因子：
120.7
通讯作者：
Schuster, Mark A.
中科院分区：
文献类型：
--
作者：
Berry, Jay G.;Toomey, Sara L.;Zaslavsky, Alan M.;Jha, Ashish K.;Nakamura, Mari M.;Klein, David J.;Feng, Jeremy Y.;Shulman, Shanna;Chiang, Vincent K.;Kaplan, William;Hall, Matt;Schuster, Mark A.
再入院率被用作病人入院期间和出院后接受的护理质量的指标。确定儿科再入院的患病率和各医院儿科再入院率的变化幅度。我们分析了全国儿童医院及相关机构协会病例组合数据集中2009年7月1日至2010年6月30日期间72家儿童医院的568,845例入院病例。考虑到年龄和慢性病指标，我们估计了各医院30天再入院率的分层回归模型。调整后再入院率高于平均值一个标准差和低于平均值一个标准差的医院分别被定义为“高”和“低”率。入院后30天因任何诊断和10个入院诊断再入院率最高的非计划再入院率。按照ICD-9-CM程序代码确定计划再入院。所有住院儿童30天未调整再入院率为6.5% （n=36,734）。再入院率高的医院调整后的再入院率比低的医院高28.6% [7.2% （95% CI 7.1-7.2%）比5.6% (95% CI 5.6-5.6%)]。对于再入院率最高的10个入院诊断，再入院率高的医院的调整率比再入院率低的医院高17.0% ~ 66.0%。例如，镰状细胞率在高医院和低医院分别为20.1% （95% CI 20.0-20.3%）和12.7% （95% CI 12.6-12.8%）。在急症儿科医院住院的患者中，30天内计划外再入院率为6.5%。不同条件和医院的再入院率存在很大差异。
Readmission rates are used as an indicator of the quality of care that patients receive during a hospital admission and after discharge. To determine the prevalence of pediatric readmissions and the magnitude of variation in pediatric readmission rates across hospitals. We analyzed 568,845 admissions at 72 children's hospitals between 7/1/2009 and 6/30/2010 in the National Association of Children's Hospitals and Related Institutions Case Mix dataset. We estimated hierarchical regression models for 30-day readmission rates by hospital, accounting for age and chronic condition indicators. Hospitals with adjusted readmission rates that were one standard deviation above and below the mean were defined as having “high” and “low” rates, respectively. Thirty-day unplanned readmissions following admission for any diagnosis and for the 10 admission diagnoses with the highest readmission prevalence. Planned readmissions were identified with ICD-9-CM procedure codes. The 30-day unadjusted readmission rate for all hospitalized children was 6.5% (n=36,734). Adjusted rates were 28.6% greater in hospitals with high vs. low readmission rates [7.2% (95% CI 7.1–7.2%) vs. 5.6% (95% CI 5.6-5.6%)]. For the 10 admissions diagnoses with the highest readmission prevalence, the adjusted rates were 17.0% to 66.0% greater in hospitals with high vs. low readmission rates. For example, sickle cell rates were 20.1% (95% CI 20.0–20.3%) vs. 12.7% (95% CI 12.6–12.8%) in high vs. low hospitals, respectively. Among patients admitted to acute care pediatric hospitals, the rate of unplanned readmissions at 30 days was 6.5%. There was wide variability in readmission rates across conditions and hospitals.
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影响因子：
4.8
作者：
Berry, Jay G.;Hall, Matthew A.;Shah, Samir S.
通讯作者：
Shah, Samir S.
DOI：
10.1161/circoutcomes.110.957613
发表时间：
2010-09-01
影响因子：
6.9
作者：
Bernheim, Susannah M.;Grady, Jacqueline N.;Krumholz, Harlan M.
通讯作者：
Krumholz, Harlan M.
影响因子：
3.4
作者：
Eselius, Laura L.;Cleary, Paul D.;Busch, Susan H.
通讯作者：
Busch, Susan H.
影响因子：
5.1
作者：
Cheney, J;Barber, S;Wainwright, C
通讯作者：
Wainwright, C
影响因子：
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作者：
Bourgeois, Fabienne C.;Olson, Karen L.;Mandl, Kenneth D.
通讯作者：
Mandl, Kenneth D.