Hospital Utilization and Characteristics of Patients Experiencing Recurrent Readmissions Within Children's Hospitals

CONTEXT: Early hospital readmission is emerging as an indicator of care quality. Some children with chronic illnesses may be readmitted on a recurrent basis, but there are limited data describing their rehospitalization patterns and impact. OBJECTIVES: To describe the inpatient resource utilization, clinical characteristics, and admission reasons of patients recurrently readmitted to children's hospitals. DESIGN, SETTING, AND PATIENTS: Retrospective cohort analysis of 317, 643 patients (n = 579, 504 admissions) admitted to 37 US children's hospitals in 2003 with follow-up through 2008. MAIN OUTCOME MEASURE: Maximum number of readmissions experienced by each child within any 365-day interval during the 5-year follow-up period. RESULTS: In the sample, 69, 294 patients (21. 8%) experienced at least 1 readmission within 365 days of a prior admission. Within a 365-day interval, 9237 patients (2. 9%) experienced 4 or more readmissions; time between admissions was a median 37 days (interquartile range IQR, 21-63). These patients accounted for 18. 8% (109, 155 admissions) of all admissions and 23. 2% (3. 4 billion) of total inpatient charges for the study cohort during the entire follow-up period. Tests for trend indicated that as the number of readmissions increased from 0 to 4 or more, the prevalences increased for a complex chronic condition (from 22. 3% n = 55, 382/248, 349 to 89. 0% n = 8225/9237; P <. 001), technology assistance (from 5. 3% n = 13, 163 to 52. 6% n = 4859; P <. 001), public insurance use (from 40. 9% n = 101, 575 to 56. 3% n = 5202; P <. 001), and non-Hispanic black race (from 21. 8% n = 54, 140 to 34. 4% n = 3181; P <. 001) ; and the prevalence decreased for readmissions associated with an ambulatory care-sensitive condition (from 23. 1% 62, 847/272, 065 to 14. 0% 15, 282/109, 155, P <. 001). Of patients readmitted 4 or more times in a 365-day interval, 2633 (28. 5%) were rehospitalized for a problem in the same organ system across all admissions during the interval. CONCLUSIONS: Among a group of pediatric hospitals, 18. 8% of admissions and 23. 2% of inpatient charges were accounted for by the 2. 9% of patients with frequent recurrent admissions. Many of these patients were rehospitalized recurrently for a problem in the same organ system.