Department of Cardiology and.
Harvard Medical School, Harvard University, Boston, Massachusetts; and.
Pediatrics. 2019 Feb;143(2). doi: 10.1542/peds.2018-1958.
Health reform and policy initiatives over the last 2 decades have led to significant changes in pediatric clinical practice. However, little is known about recent trends in pediatric hospitalizations and readmissions at a national level.
Data from the 2010-2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database and National Inpatient Sample were analyzed to characterize patient-level and hospital-level trends in annual pediatric (ages 1-17 years) admissions and 30-day readmissions. Poisson regression was used to evaluate trends in pediatric readmissions over time.
From 2010 to 2016, the total number of index admissions decreased by 21.3%, but the percentage of admissions for children with complex chronic conditions increased by 5.7%. Unadjusted pediatric 30-day readmission rates increased over time from 6.26% in 2010 to 7.02% in 2016 with a corresponding increase in numbers of admissions for patients with complex chronic conditions. When stratified by complex or chronic conditions, readmission rates declined or remained stable across patient subgroups. Mean risk-adjusted hospital readmission rates increased over time overall (6.46% in 2010 to 7.14% in 2016) and in most hospital subgroups but decreased over time in metropolitan teaching hospitals.
Pediatric admissions declined from 2010 to 2016 as 30-day readmission rates increased. The increase in readmission rates was associated with greater numbers of admissions for children with chronic conditions. Hospitals serving pediatric patients need to account for the rising complexity of pediatric admissions and develop strategies for reducing readmissions in this high-risk population.
在过去的 20 年中，医疗改革和政策举措导致儿科临床实践发生了重大变化。然而，对于全国范围内儿科住院和 30 天再入院的最新趋势知之甚少。
对 2010-2016 年医疗保健成本和利用项目全国再入院数据库和全国住院患者样本中的数据进行分析，以描述患者和医院层面上儿科（1-17 岁）入院和 30 天再入院的年度趋势。采用泊松回归评估儿科再入院随时间的变化趋势。
从 2010 年到 2016 年，指数入院的总数减少了 21.3%，但患有复杂慢性病的儿童入院比例增加了 5.7%。未经调整的儿科 30 天再入院率随时间增加，从 2010 年的 6.26%增加到 2016 年的 7.02%，同时患有复杂慢性病的患者入院人数相应增加。按复杂或慢性疾病分层，各患者亚组的再入院率下降或保持稳定。总体而言，调整后的平均风险医院再入院率随时间推移而增加（从 2010 年的 6.46%增加到 2016 年的 7.14%），并且在大多数医院亚组中均增加，但在大都市教学医院中随时间推移而下降。
2010 年至 2016 年，儿科住院人数减少，30 天再入院率增加。再入院率的增加与患有慢性病的儿童入院人数增加有关。为儿科患者服务的医院需要考虑到儿科入院的复杂性不断增加，并制定策略以减少这一高风险人群的再入院率。
