Childhood Hospital Readmissions Linked to Chronic, Complex Conditions

Mark Brittan MD MPH Assistant Professor, Pediatric Hospital Medicine Children's Hospital Colorado University of Colorado School of Interview with:
Mark Brittan MD MPH
Assistant Professor, Pediatric Hospital Medicine
Children’s Hospital Colorado
University of Colorado School of Medicine

MedicalResearch: What is the background for this study? What are the main findings?

Dr. Brittan: As hospitals face reimbursement penalties for excess readmissions, clinicians are increasingly focused on improving care transitions in order to reduce readmissions. We are interested in learning about feasible ways to reduce pediatric readmissions so that we can improve the quality of care and experience of children and families who are being discharged from the hospital. The purpose of this study was to assess whether outpatient follow-up visits after hospital discharge can help to prevent readmissions. We chose to examine this question in a population of medically complex children enrolled in Medicaid. Children with medical complexity account for a growing proportion of pediatric hospitalizations and inpatient costs. These children are often dependent on technology (for example, ventilator machines, feeding tubes, and chronic indwelling catheters), and can have very complex care plans and medication regimens. Publically insured children are also vulnerable to increased hospital utilization and may not always have optimal or easy access to outpatient services. Showing a relationship between post-discharge outpatient visits and fewer readmissions would suggest that improvements in coordination of care or access to outpatient follow-up care may help to reduce readmissions in these children. To assess this relationship, we retrospectively analyzed 2006-2008 Colorado Medicaid claims data from which we were able to gather demographic, clinical, and visit information for all enrollees.

In our study, we excluded children who were readmitted within 3 days of hospital discharge so that we could evaluate children who had a chance to follow-up. The study cohort included 2415 medically complex children aged 6 months to 18 years who were hospitalized at least once. Of these children, 6.3% were readmitted on days 4 – 30 after hospital discharge. Almost 22% of the children had an outpatient follow-up visit within 3 days of discharge, and 40% had a visit on days 4-29 after discharge. In the final analysis, we found expected associations between readmission and previously described risk factors, including number of patient comorbidities and longer initial hospital length of stay. Examining the relationship between outpatient follow-up and readmission, we found that children with later outpatient follow-up visits (days 4-29) were significantly less likely to be readmitted than those who did not have an outpatient visit on days 4-29 after discharge.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Brittan: It is important for clinicians and patients/families to be aware that children with chronic and complex conditions are more likely to experience readmission than otherwise healthy children who are hospitalized with acute illnesses. Our study suggests that rates of post-discharge outpatient follow-up may be lower than expected. Ensuring that medically complex children follow-up after hospitalization can help clinicians to identify and mitigate hospital-related problems before they become serious enough to require readmission. Increasing rates of outpatient follow-up may help to prevent readmissions for these children and their families.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Brittan: It would be important to replicate these findings for other pediatric patient populations, and for children in other regions of the country. Our study had several limitations related to its retrospective design. A prospective study examining the impact of an intervention to increase post-discharge outpatient follow-up may help to provide additional evidence for the importance of transitional care continuity in reducing hospital readmissions for children with medical complexity.


Outpatient Follow-Up Visits and Readmission in Medically Complex Children Enrolled in Medicaid

 Mark S. Brittan, MD, MPH Marion R. Sills, MD1, 2,David Fox, MD1, 2,Elizabeth J. Campagna, MS2,Doron Shmueli, MS2,James A. Feinstein, MD, MPH1, 2,Allison Kempe, MD, MPH1, 2

The Journal of Pediatrics Available online 29 January 2015

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