Key result
Following discharge from a post-acute care hospital, 22% of children with medical complexity were readmitted within 90 days, with readmitted children more likely to have high medical severity (68% vs 31%, P=0.04).
Cohort (n=448)
The majority of children with medical complexity discharged home from a post-acute care hospital do not require acute care readmission within 3 months, though those with greater medical severity are at higher risk.
Supports risk stratification by severity for post-discharge care; leaves open prospective validation and intervention trials.
OBJECTIVES: Of all hospitalized children, those with medical complexity have the highest likelihood of hospital readmission. Post-acute hospital care could potentially help stabilize the health of these children. We examined the frequency of acute care hospital admissions after discharge home from a post-acute care hospital (PACH). METHODS: A retrospective cohort analysis of 448 children with medical complexity discharged from a PACH from January 1, 2010, to December 31, 2015, with the main outcomes of acute care hospital readmissions 0 to 30 and 31 to 90 days after discharge home from a PACH. Demographic and clinical characteristics were compared between children with and without acute care readmission and between the 2 readmission groups. RESULTS: Ninety-nine children (22%) had a readmission to the acute care hospital. Of these readmissions, 61 (62%) occurred between 0 and 30 days and 38 (38%) between 31 and 90 days after PACH discharge. A higher percentage of children readmitted had high medical severity (>3 systems involved or ventilator dependent) compared with children not readmitted (68% vs 31%, P = .04). No differences were found between children who were readmitted and those who were not by sex, race, payer, length of stay, or age at PACH discharge. Additionally, no differences were found between children readmitted within 30 days and children readmitted 31 to 90 days after PACH discharge. CONCLUSIONS: The majority of children discharged home from a PACH do not require an acute care hospitalization within the first 3 months. Children with greater medical severity are readmitted more often than others.
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O’Brien et al. (2017) conducted a cohort in medical complexity (n=448). Discharge home from a post-acute care hospital was evaluated on acute care hospital readmissions 0 to 30 and 31 to 90 days after discharge home. Following discharge from a post-acute care hospital, 22% of children with medical complexity were readmitted within 90 days, with readmitted children more likely to have high medical severity (68% vs 31%, P=0.04).
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