Risk Factors for Readmission to Medicine Critical Care Units at Boston Children's Hospital
Estrada Alamo, Carlos Eduardo
MetadataShow full item record
CitationEstrada Alamo, Carlos Eduardo. 2018. Risk Factors for Readmission to Medicine Critical Care Units at Boston Children's Hospital. Doctoral dissertation, Harvard Medical School.
AbstractStatement of the Problem/Background: Nationally, there is increasing focus on hospital readmission rates as an indicator of quality of care. Thirty-day readmission rates range from approximately 5% for pediatric hospital discharges overall to up to 25% for children with complex care needs. For children with complex chronic conditions, dependence on medical technology has been significantly associated with increased readmission rates. Due to technology dependence, some children may be directly discharged from an intensive care or intermediate care units. It is yet unclear which factors contribute to the risk of readmission in patients discharged directly from these units.
Research Question/Hypothesis: The objectives of this study were to describe the inpatient Medicine Critical Care patient population experiencing readmission to Boston Children’s Hospital. Our primary hypothesis was that patients with chronic care conditions and those with technology assistance discharged from medicine critical care had a high rate of readmission within 90 days.
Research Design/Methods Used in the Investigation: Medicine Critical Care is comprised of a Medicine Intensive Care Unit and an Intermediate Care Unit with a total of 2,052 admissions in 2012. All patients discharged home or transferred to an outside hospital from the Medicine Critical Care units from January 1 to April 15, 2012 were screened for this study. Chronic diagnosis prevalence (i.e., technology assistance and medical consultants prior to index admission) and reasons for hospitalization were assessed. Demographic and clinical data was collected retrospectively. Admission and discharge data, including medical consultations and presence of invasive technologies, were obtained from medical chart review. Children were considered to have a chronic care condition if they had ≥ 3 medical consultations prior to index admission. Children met technology assistance criteria if they had a respiratory technology requirement such as tracheostomy or requirement for noninvasive positive pressure or continuous positive airway pressure, need for feeding technology such as via a nasogastric, nasoduodenal, gastrostomy or jejunotomy tube, and/or a permanent central line.
Results/Summary of the Investigation: From January 1, 2012 to April 15, 2013, 383 patients were discharged directly home or transferred to an outside hospital. One hundred ninety-five patients (50.9% [n=195/383]) met chronic care condition criteria prior to index admission. A total of 199 patients (52.0% [n=199/383]) were discharged with supports meeting the technology assistance criteria. One hundred and one patients (26.4% [n=101/383]) experienced at least one readmission within ninety days of the index discharge event. Ninety-day readmission rates were higher for patients meeting complex chronic condition criteria (42.6% [n=83/195] versus 9.6% [n=18/188]) and for patients meeting technology assistance criteria (42.2% [n=84/199] versus 9.2% [n=17/184]).
Interpretation/Conclusion of the Investigation: Patients with complex chronic conditions and/or technology assistance discharged from the Medicine Critical Care units at Boston Children’s Hospital experience higher readmission rates than patients not meeting these criteria. Further research is needed to explore additional factors that may influence readmission rates in these cohorts. Research findings may result in the development of a strategy to identify and manage patients at high- and low-risk for early readmission. Reducing the rates of early readmission will ideally lead to improved overall care by improving transitions to the medical home, and may reduce overall health care costs.
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41973490