Key result
Pediatric nonindex readmissions linked to ~28% more unplanned ED visits and higher morbidity vs index readmissions.
Why the study?
Increasing pediatric care regionalization may fragment care if children are readmitted to nonindex hospitals, raising the question of whether readmission destination affects clinical outcomes.
Does nonindex readmission worsen clinical outcomes and resource utilization in pediatric patients compared to index readmission?
Cohort (n=41,107)
Yes
Does nonindex readmission worsen clinical outcomes and resource utilization in pediatric patients compared to index readmission?
Pediatric nonindex readmissions are associated with worse health outcomes and higher resource utilization compared to index readmissions.
Nonindex pediatric readmissions warrant heightened vigilance for morbidity; this observational link leaves open whether targeted coordination improves outcomes.
OBJECTIVES: Increasing pediatric care regionalization may inadvertently fragment care if children are readmitted to a different (nonindex) hospital rather than the discharge (index) hospital. Therefore, this study aimed to assess trends in pediatric nonindex readmission rates, examine the risk factors, and determine if this destination difference affects readmission outcomes. METHODS: In this retrospective cohort study, we use the Healthcare Cost and Utilization Project State Inpatient Database to include pediatric (0 to 18 years) admissions from 2010 to 2017 across Florida hospitals. Risk factors of nonindex readmissions were identified by using logistic regression analyses. The differences in outcomes between index versus nonindex readmissions were compared for in-hospital mortality, morbidity, hospital cost, length of stay, against medical advice discharges, and subsequent hospital visits by using generalized linear regression models. RESULTS: Among 41 107 total identified readmissions, 5585 (13.6%) were readmitted to nonindex hospitals. Adjusted nonindex readmission rate increased from 13.3% in 2010% to 15.4% in 2017. Patients in the nonindex readmissions group were more likely to be adolescents, live in poor neighborhoods, have higher comorbidity scores, travel longer distances, and be discharged at the postacute facility. After risk adjusting, no difference in in-hospital mortality was found, but morbidity was 13% higher, and following unplanned emergency department visits were 28% higher among patients with nonindex readmissions. Length of stay, hospital costs, and against medical advice discharges were also significantly higher for nonindex readmissions. CONCLUSIONS: A substantial proportion of children experienced nonindex readmissions and relatively poorer health outcomes compared with index readmission. Targeted strategies for improving continuity of care are necessary to improve readmission outcomes.
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Symum et al. (2021) conducted a cohort in Pediatric readmission (n=41,107). Nonindex readmission vs. Index readmission was evaluated on In-hospital mortality, morbidity, hospital cost, length of stay, against medical advice discharges, and subsequent hospital visits. Pediatric nonindex readmissions were associated with 13% higher morbidity and 28% higher subsequent unplanned emergency department visits compared with index readmissions.
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