Study questions usefulness of hospital readmission rates as marker of care quality for pediatric sickle cell disease
Thirty-day readmission rates are gaining use in medicine as a marker of health care quality. However, the use of the 30-day readmission rate as a measure of care quality for sickle cell crisis is supported by only a few studies and debate remains about its value.
A new study assessing this measure in a large database has found that 17 percent of hospitalizations for children with sickle cell crisis result in readmission within 30 days. The Boston-based research team also found substantial variation in readmission rates among the 33 hospitals included in the study. Older children, those treated with corticosteroids, and children hospitalized for pain were more likely to be readmitted within 30 days, while patients who received a red blood cell transfusion were less likely to be readmitted. After accounting for patient clustering, almost all hospitals had a significant drop in readmission rate. This means that a small number of patients account for a disproportionate number of admissions. It also suggests that crude readmission rates do not account for these patients, whose needs for both inpatient and outpatient services are significant.
The researchers believe that if readmission rates are going to be used as a care quality marker for sickle cell disease in children, that they be adjusted for case mix and for clustering by patient, given that this is a chronic disease where the burden on the health care system is often based on a subset of patients. The study was based on 12,104 admissions for sickle cell crisis, representing 4,762 patients among 33 hospitals over a 2.5-year period. The study was supported by the Agency for Healthcare Research and Quality (T32 HS00063).
See "Thirty-day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: Risk factors and hospital variation" by Amy Sobota, M.D., Dionne A. Graham, PhD, Ellis J. Neufeld, M.D., PhD, and Matthew M. Heeney, M.D. in Pediatric Blood Cancer 58, pp. 61-65, 2012.
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