(Press-News.org) Among a group of children's hospitals, nearly 20 percent of admissions and one-quarter of inpatient expenditures were accounted for by a small percentage of patients who have frequent recurrent admissions, according to a study in the February 16 issue of JAMA.
Hospital readmission is increasingly considered an indicator of quality of care. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data regarding the impact of their rehospitalizations, according to background information in the article. "Children with chronic conditions may require multiple, unavoidable, and necessary hospitalizations (such as chemotherapy for leukemia) to improve their health status. On the other hand, repeat admissions felt to be amenable to high-quality outpatient care (asthma- and seizure-related admissions, for example) or related to the same medical problem may be considered potentially avoidable."
Jay G. Berry, M.D., M.P.H., of Children's Hospital Boston and Harvard Medical School, and colleagues examined the inpatient resource usage of children experiencing recurrent hospital readmissions and evaluated the clinical and demographic characteristics of patients and the reasons for readmission. The analysis included 317,643 patients (n = 579,504 admissions) admitted to 37 U.S. children's hospitals in 2003 with follow-up through 2008. Among the outcomes measured included the maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period.
Among the sample, 69,294 patients (21.8 percent) experienced 1 or more readmission within 365 days of a prior admission. Among them, 9,237 patients (2.9 percent) experienced 4 or more readmissions within a 365-day interval with a median (midpoint) of 37 days between their admissions. Despite comprising only 2.9 percent of patients in the group, these patients accounted for 18.8 percent (109,155) of admissions, 23.4 percent (491,815) of bed-days, and 23.2 percent ($3.42 billion) of total inpatient charges for the study group during the entire follow-up period.
As readmission frequency increased from 0 to 4 or more, there was an increase in the percentage of children ages 13 to 18 years; adult patients older than 18 years; patients who had public insurance; non-Hispanic black patients; and patients with 1 or more complex chronic conditions (CCC). Also, as readmission frequency increased from 0 to 4 or more, the percentage of technology assistance increased and the percentage of hospitalizations associated with an ambulatory care-sensitive condition (ACSC) decreased.
Among patients with 4 or more readmissions within a 365-day interval, 28.5 percent were hospitalized for a problem in the same organ system during the interval.
Neuromuscular CCCs were the most prevalent disease group among patients frequently readmitted; asthma was the most common ACSC and a respiratory problem was one of the most common major diagnostic categories encountered repeatedly across patients' multiple readmissions.
The authors write that the attributes of pediatric patients at risk for recurrent readmissions observed in this study suggest that heightened complexity of discharge care planning may be needed to ensure their safe transition from the hospital. "Those patients with multiple CCCs and technology assistance may require communication, proactive care planning, and follow-up appointments with multiple outpatient specialty providers, equipment specialists, and home nurses at discharge. High-quality discharge care planning, including timely communication with outpatient providers regarding hospitalization course and postdischarge care instructions, may be an important mitigating factor to minimize readmission. However, this planning may not prevent multiple future readmissions in children at risk for them if the outpatient providers and health system are underequipped to meet their health care needs, optimally manage their acute illnesses, and minimize their chronic illness exacerbations."
###
(JAMA. 2011;305[7]682-690. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact Jay G. Berry, M.D., M.P.H., call Elizabeth Andrews at 617-919-3110 or email elizabeth.andrews@childrens.harvard.edu.
For More Information: Contact the JAMA/Archives Media Relations Department at 312-464-JAMA or email: mediarelations@jama-archives.org.
Large portion of costs at children's hospitals accounted for by patients with frequent readmissions
2011-02-16
ELSE PRESS RELEASES FROM THIS DATE:
Method of DNA repair linked to higher likelihood of genetic mutation
2011-02-16
Accurate transmission of genetic information requires the precise replication of DNA. Errors in DNA replication are common and nature has developed several cellular mechanisms for repairing these mistakes. Mutations, which can be deleterious (development of cancerous cells), or beneficial (evolutionary adaption), arise from uncorrected errors. Researchers from Indiana University-Purdue University Indianapolis (U.S.A) and Umea° University (Sweden) report that a method by which cells repair breaks in their DNA, known as Break-induced Replication (BIR), is up to 2,800 times ...
Zinc reduces the burden of the common cold
2011-02-16
Zinc supplements reduce the severity and duration of illness caused by the common cold, according to a systematic review published in The Cochrane Library. The findings could help reduce the amount of time lost from work and school due to colds.
The common cold places a heavy burden on society, accounting for approximately 40% of time taken off work and millions of days of school missed by children each year. The idea that zinc might be effective against the common cold came from a study carried out in 1984, which showed that zinc lozenges could reduce how long symptoms ...
Safety of biologic treatment for arthritis depends on the drug
2011-02-16
Some biologic drugs may be safer than others according to a new systematic review by Cochrane researchers. Biologics are a broad class of drugs based on biological molecules. The drugs are used to reduce inflammation in diseases such as rheumatoid arthritis and inflammatory bowel disease.
Although the effectiveness of biologics is now well established, it is thought that some may have rare but serious side effects related to their immune-suppressing activities. Links have been made to increased risk of infections, reactivation of tuberculosis (TB), cancer and congestive ...
Tick population plummets in absence of lizard hosts
2011-02-16
Berkeley — The Western fence lizard's reputation for helping to reduce the threat of Lyme disease is in jeopardy. A new study led by researchers at the University of California, Berkeley, found that areas where the lizard had been removed saw a subsequent drop in the population of the ticks that transmit Lyme disease.
"Our expectation going into this study was that removing the lizards would increase the risk of Lyme disease, so we were surprised by these findings," said study lead author Andrea Swei, who conducted the study while she was a Ph.D. student in integrative ...
Study finds blacks more likely to be readmitted to hospitals after discharge
2011-02-16
Boston, MA – Elderly black patients were more likely to be readmitted to the hospital after a prior hospital stay for a heart attack, heart failure, or pneumonia, according to a new study from Harvard School of Public Health (HSPH) researchers. They found that the higher readmission rates were due to disparities related to both race and the hospitals where patients were treated.
"Disparities in health and health care are well-documented in this country, but little was previously known about whether there were disparities in hospital readmissions at the national level," ...
Calorie labeling has no effect on teenagers' or parents' food purchases
2011-02-16
(New York, NY) February 15, 2011 – A new study led by an NYU School of Medicine investigator and published in the February 15, 2011, Advance Online Publication, International Journal of Obesity, challenges the idea that calorie labeling has an effect on the purchasing behavior of teenagers or what parents purchase for their children. Teens appear to notice the calorie information at the same rate as adults, however they respond at a lower rate. The conclusions are similar to a previous study about adult eating behavior by Dr. Brian Elbel, assistant professor and colleagues, ...
Losing hair at 20 is linked to increased risk of prostate cancer in later life
2011-02-16
Men who start to lose hair at the age of 20 are more likely to develop prostate cancer in later life and might benefit from screening for the disease, according to a new study published online in the cancer journal, Annals of Oncology [1] today.
The French study compared 388 men being treated for prostate cancer with a control group of 281 healthy men and found that those with the disease were twice as likely as the healthy men to have started going bald when they were 20. However, if the men only started to lose their hair when they were 30 or 40, there was no difference ...
Frequent, potentially avoidable readmissions are major driver of pediatric health care care costs
2011-02-16
Boston, Mass. - Hospital readmissions are increasingly viewed as an indicator of quality of care. If patients receive appropriate discharge care planning and coordinated outpatient follow-up when leaving the hospital, they should transition safely home without the need to return to the hospital. n a retrospective study of inpatient records at 37 free-standing children's hospitals between 2003 and 2008, nearly 20 percent of admissions and one-quarter of inpatient expenditures ($3.4 billion) were accounted for by a small group (2.9 percent) of patients who were readmitted ...
UT Southwestern launches clinical trial for treatment of breast cancer using CyberKnife
2011-02-16
DALLAS – Feb. 15, 2011 – Breast-cancer patient Kristin Wiginton is the first to be treated at UT Southwestern Medical Center with high-beam radiation using the Accuray CyberKnife System, which offers improved cosmetic results, less radiation exposure to surrounding tissue and a shorter treatment period.
Dr. Wiginton is among 45 participants in a UT Southwestern-based clinical trial – the first of its kind in the Southwest – investigating use of the radiation delivery system for breast cancer. Her post-lumpectomy therapy lasted one-third the duration of a typical radiation ...
US Secret Service moves Tiny Town to Virtual Tiny Town
2011-02-16
Chemical releases, suicide bombers, air and subsurface threats: the U.S. Secret Service needs to be prepared to handle these real-life incidents. Training to respond to such incidents, however, has been more theoretical than practical.
Now, with help from the Department of Homeland Security (DHS) Science & Technology Directorate (S&T), the Secret Service is giving training scenarios a high-tech edge: moving from static tabletop models to virtual kiosks with gaming technology and 3D modeling.
For the past 40 years, a miniature model environment called "Tiny Town" ...