Measuring hospital quality using pediatric readmission and revisit rates

Abstract

Objective: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals.

Methods: 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.

Results: 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%).

Conclusions: 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.

Keywords: child health research; delivery of care; health policy; hospital performance variation; quality measurement; readmission rates.

FIGURE 1

Risk-standardized hospital-level 30-day pediatric asthma readmission rates. Each point represents the risk-standardized readmission rate of a hospital with at least 25 pediatric asthma readmissions over 2 years (n = 278); the error bars represent the 95% CI. Outliers are hospitals with CIs above (poor performers, n = 4) or below (superior performers, n = 1) the group mean rate of 6.3% (horizontal line). Risk-adjustment variables were age, gender, and presence or absence of a CCC.^,