Rehospitalization for childhood asthma: timing, variation, and opportunities for intervention.

Kenyon CC¹, Melvin PR², Chiang VW³, Elliott MN⁴, Schuster MA³, Berry JG³.

Author information

Abstract

OBJECTIVE:

To
assess the timing of pediatric asthma rehospitalization, variation in
rate of rehospitalization across hospitals, and factors associated with
rehospitalization at different intervals.

STUDY DESIGN:

Retrospective
cohort analysis of 44,204 hospitalizations for children with asthma
within 42 children's hospitals between July 2008 and June 2011. The main
outcome measures were rehospitalization for asthma within 7, 15, 30,
60, 180, and 365 days of an index asthma admission.

RESULTS:

The
rate of asthma rehospitalization ranged from 0.5% (n = 208) at 7 days
to 17.2% (n = 7603) at 365 days. Black patients and patients with public
insurance had higher odds of rehospitalization at 60 days and beyond (P
≤ .01 for both). Adolescents (12- to 18-year-old), patients with a
diagnosis of a complex chronic condition, and patients with a prior year
asthma admission had higher odds of rehospitalization at every time
interval (P ≤ .001 for all). Significant hospital variation in case-mix
adjusted rates of rehospitalization existed at each time interval (P ≤
.01 for all). Rates at 365 days were ≤ 10.9% for the top 10% of
hospitals; if all hospitals achieved this rate, 36.6% of
rehospitalizations might have been avoided.

CONCLUSIONS:

Significant
variation in asthma rehospitalization rates exists across children's
hospitals from 7 to 365 days after an index admission. Racial/ethnic and
economic disparities emerge at 60 days. By 1 year, rehospitalizations
account for 1 in 6 hospitalizations. Assessing asthma rehospitalizations
at longer intervals may augment our current understanding of and
approach to post-hospitalization care improvement.

Copyright © 2014 Mosby, Inc. All rights reserved.

KEYWORDS:

APR-DRG,
All-Patient Refined Diagnosis-Related Group, CCC, Complex chronic
condition, ICU, Intensive care unit, PHIS, Pediatric Health Information
System