Hospital Performance: Readmission Rates Are Not the Indicator

Photo: Emergency sign

When comparing hospitals’ performance based on revisits, few hospitals that care for children can be identified as being better or worse than average; ©
Braden Gunem

Readmission rates of adult patients to the same hospital within 30 days are an area of national focus and a potential indicator of clinical failure and unnecessary expenditures.

However, a new study at the University of California San Francisco (UCSF) shows that hospital readmissions rates for children are not necessarily meaningful measures of the quality of their care.

In the first multi-state study of children’s and non-children’s hospitals, assessing pediatric readmission and revisit rates – being admitted into the hospital again or visiting the emergency room within 30 days of discharge – for common pediatric conditions, the researchers found that diagnosis-specific readmission and revisit rates are limited in their usefulness as a quality indicator for pediatric hospital care.

The study found that when comparing hospitals’ performance based on revisits, few hospitals that care for children can be identified as being better or worse than average, even for common pediatric diagnoses.

“As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care,” said Dr. Naomi Bardach, lead author. “Measuring and reporting them publicly would waste limited hospital and health care resources.”

Using a multistate database called the State Inpatient and Emergency Department Databases, the researchers looked at 958 hospitals admitting children, which were mostly large or medium-sized, and urban. Focusing on seven common inpatient pediatric conditions – asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders and epilepsy – the researchers then calculated the rates of readmissions and revisits to the hospital within 30 and 60 days of discharge, broken down by the condition for which they were treated.

All of the hospitals in the study had 30-day readmission rates of less than 5 percent in all areas except for epilepsy (6.1 percent), dehydration (6 percent) and mood disorders (7.6 percent).

“With average 30-day readmission rates hovering around 5 percent, there is little space for a hospital to be identified as having better performance,” said Bardach.

For example, of the more than 900 hospitals admitting children, looking at revisit rates for:

• Asthma – One performed better than average and four performed worse;
• Appendicitis – Two performed better than average and two performed worse;
• Pneumonia and dehydration – no hospitals were better or worse than all the other hospitals; and
• Seizures – Only one hospital of more than 600 was different than average, performing worse than the others.

“The low number of outliers is likely due to the fact that most hospitals just don’t admit very many kids, because children are healthier than adults,” said Bardach.; Source: University of California San Francisco (UCSF)