Pediatric readmission rates vary across patient race, ethnicity
SAN FRANCISCO — Among children hospitalized with asthma or diabetes, non-Hispanic black patients have the highest rates of readmission, while readmission rates among those hospitalized with seizure or migraine are highest among non-Hispanic whites, according to data presented at the 2016 AAP National Conference and Exhibition.
“Preventing hospital readmissions continues to be a key aim of health system initiatives striving to optimize the quality of transitions of care for hospitalized patients,” Kavita Parikh, MD, MSHS, of the George Washington University Medical Center, in Washington, D.C., told Healio Family Medicine. “Unfortunately, the effectiveness of discharge and follow-up care is not equitable across all hospitalized children.”
To analyze pediatric readmission patterns, both in terms of timing and extent, by racial/ethnic groups over a 1-year period, Parikh and colleagues conducted a multi-centered study covering 96,094 readmissions at 48 children’s hospitals in the Pediatric Health Information System. Readmission conditions included asthma (36,910 cases), seizure (35,361), diabetes (12,468), migraine (5,882) and depression (5,132).
The researchers calculated readmission rates by week over a period of 1 year following the initial admission, and analyzed the rates by the patient’s race or ethnicity, including non-Hispanic white, non-Hispanic black, Hispanic and “other.” They then used generalized linear mixed effects models, with a random effect hospital, to determine the likelihood of readmission, adjusting for severity of illness, age, payer and medical complexity.
According to the researchers, variation by racial/ethnic group was similar for diabetes and asthma, with differences emerging at 3 and 4 weeks, respectively, and remaining divergent for 1 year. The highest readmission rates at 12 months for both conditions occurred among non-Hispanic black patients — 21.7% for diabetes and 21.4% for asthma. Variation by race/ethnicity was also similar for migraine and seizure, with differences emerging at 6 and 7 weeks, respectively, and remaining divergent for 1 year. At 12 months, the highest readmission rates for migraine and seizure were seen among non-Hispanic white patients, at 17.3% and 23.9% respectively. No disparities were reported for depression during the study period.
“As more emphasis is made on value-based care, payers and policy makers will continue to identify excessive health care utilization and preventable costs,” Parikh said. “Racial and ethnic differences in hospital readmission are important to remember in these efforts, as they could indicate an area for improvement. The quality of hospital discharge care might not be mainly responsible for them, so addressing the true reason for health inequities in children with chronic conditions will be important to help manage their care and optimize their health in the long term.” – by Jason Laday
Parikh, K, et al. Racial disparities in pediatric readmissions for common inpatient chronic conditions. Presented at: 2016 AAP National Conference and Exhibition; Oct. 22-25; San Francisco.
Disclosure: Parikh reports no relevant financial disclosures.