Same-hospital readmission rates as a measure of pediatric quality of care

Abstract

Importance Health care systems, payers, and hospitals use hospital readmission rates as a measure of quality. Although hospitals can track readmissions back to themselves (hospital A to hospital A), they lack information when their patients are readmitted to different hospitals (hospital A to hospital B). Because hospitals lack different-hospital readmission (DHR) data, theymay underestimate all-hospital readmission (AHR) rates (hospital A to hospital A or B). Objectives To determine the prevalence of 30-day pediatric DHRs; to assess the effect of DHR on readmission performance; and to identify patient and hospital characteristics associated with DHR. Design, Setting, and Participants We analyzed all-payer inpatient claims for 701 263 pediatric discharges (patients aged 0-17 years) from 177 acute care hospitals in New York State from January 1, 2005, through November 30, 2009, to identify 30-day same-hospital readmissions (SHRs), DHRs, and AHRs. Data analysis was performed from March 12, 2013, through April 6, 2015.We compared excess readmission ratios (calculated per the Medicare formula) using SHRs and AHRs to determine what might happen if the federal formula were applied to a specific state and to evaluate how often hospitals might accurately anticipate\- using data available to them\-whether they would incur penalties (excess readmission ratio >1) for readmissions. Using multivariate logistic regression, we identified patient- and hospital-level predictors of DHR vs SHR. Main Outcomes and Measures The proportion of DHRs vs SHRs, AHR and SHR rates, and excess readmissions. Results Different-hospital readmissions constituted 13.9%of 31 325 AHRs. At the individual hospital level, the median (interquartile range) percentage of DHRs was 21.6%(12.8%-39.1%). The median (interquartile range) adjusted AHR rate was 3.4%(3.0%-4.1%), 38.9%higher than the median adjusted SHR rate of 2.5%(2.0%-3.4%) (P < .001). Excess readmission ratios.