Wallace Sowdhamini S, Keller Stacey L, Falco Carla N, Nead Jennifer A, Minard Charles G, Nag Pratip K, Quinonez Ricardo A
Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Texas Children's Hospital, Houston, Texas;
Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Section of Pediatric Hospital Medicine, Children's Hospital of San Antonio, San Antonio, Texas; and.
Hosp Pediatr. 2015 Nov;5(11):566-73. doi: 10.1542/hpeds.2015-0015.
The purpose of this study was to describe the characteristics and reasons for pediatric hospital medicine readmissions. We also aimed to describe characteristics of potentially preventable cases and the reliability of classification.
Retrospective descriptive study from December 2008 through June 2010 in a large academic tertiary care children's hospital in Houston, Texas. Children were included if they were readmitted to the hospital within 30 days of discharge from the pediatric hospital medicine service. Reasons for readmission were grouped into three categories: physician-related, caretaker-related, and disease-related. Readmissions with physician- or caretaker-related reasons were considered potentially preventable.
The overall readmission rate was 3.1%, and a total of 204 subjects were included in the analysis. Lymphadenitis and failure to thrive had the highest readmission rates with 21%, and 13%, respectively. Twenty percent (n=41/204) of readmissions were preventable with 24% (n=10/41) being physician-related, 12% (n=5/41) caregiver-related, and 63% (n=26/41) for mixed reasons. When comparing classification of readmissions into preventable status, there was moderate agreement between 2 reviewers (K=0.44, 95% confidence interval: 0.28-0.60). Among patients with preventable readmission, the probability of having had a readmission by 7 days and 15 days was 73% and 78%, respectively.
Reliable identification of preventable pediatric readmissions using individual reviewers remains a challenge. Additional studies are needed to develop a reliable approach to identify preventable readmissions and underlying modifiable factors. A focused review of 7-day readmissions and diagnoses with high readmission rates may allow use of fewer resources.
本研究旨在描述儿科医院再入院的特征及原因。我们还旨在描述潜在可预防病例的特征及分类的可靠性。
对2008年12月至2010年6月期间在德克萨斯州休斯顿一家大型学术性三级医疗儿童医院进行的回顾性描述性研究。如果儿童在儿科医院医疗服务出院后30天内再次入院，则纳入研究。再入院原因分为三类：医生相关、照顾者相关和疾病相关。与医生或照顾者相关原因导致的再入院被认为是潜在可预防的。
总体再入院率为3.1%，共有204名受试者纳入分析。淋巴结炎和发育不良的再入院率最高，分别为21%和13%。20%（n = 41/204）的再入院是可预防的，其中24%（n = 10/41）与医生相关，12%（n = 5/41）与照顾者相关，63%（n = 26/41）是混合原因。当比较再入院分类为可预防状态时，两名评审员之间存在中度一致性（K = 0.44，95%置信区间：0.28 - 0.60）。在可预防再入院的患者中，7天和15天内再次入院的概率分别为73%和78%。
使用个体评审员可靠识别可预防的儿科再入院仍然是一项挑战。需要进一步研究以开发一种可靠的方法来识别可预防的再入院及潜在的可改变因素。对7天内再入院和再入院率高的诊断进行重点审查可能会减少资源使用。
