Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
Pediatrics. 2013 Sep;132(3):429-36. doi: 10.1542/peds.2012-3527. Epub 2013 Aug 26.
To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals.
In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1-20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean.
Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%-82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%-15.9%).
We found that when comparing hospitals' performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement.
评估医院在儿科再入院和再就诊率方面的差异，并确定高绩效和低绩效医院的数量。
利用 Healthcare Cost and Utilization Project 的 State Inpatient 和 Emergency Department Databases 进行回顾性分析，利用复诊链接，我们确定了儿科（1-20 岁）的 7 种常见住院儿科疾病（哮喘、脱水、肺炎、阑尾炎、皮肤感染、情绪障碍和癫痫）之一的就诊。对于每种疾病，我们计算了所有原因再入院率和 30 天和 60 天内再就诊率（再入院或急诊就诊）。我们使用混合逻辑模型估计医院水平的风险标准化 30 天再就诊率，并确定绩效与组平均值统计学上不同的医院。
所有疾病的 30 天再入院率均较低（<10.0%）。30 天内再次到住院或急诊就诊的比例为 6.2%（阑尾炎）至 11.0%（情绪障碍）。研究医院（n=958）的特定疾病就诊量较低（37.0%-82.8%的医院就诊量<25 例）。只有一种疾病有>1%的医院在 30 天风险标准化再就诊率方面被标记为与平均值不同，即情绪障碍（4.2%的医院[n=15]，医院绩效范围为 6.3%-15.9%）。
我们发现，当将医院的表现与平均值进行比较时，很少有儿科医院被确定为再就诊的高绩效或低绩效医院，即使是针对常见的儿科诊断，这可能是由于医院就诊量较低。这限制了特定疾病的再入院或再就诊指标在儿科质量测量中的有用性。
