National Healthcare Quality and Disparities Report
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Topics
- Adverse Events (1)
- Ambulatory Care and Surgery (1)
- Caregiving (1)
- (-) Children/Adolescents (16)
- Chronic Conditions (2)
- Diagnostic Safety and Quality (1)
- Emergency Department (1)
- Healthcare-Associated Infections (HAIs) (1)
- Healthcare Cost and Utilization Project (HCUP) (3)
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- Hospital Discharge (4)
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- (-) Hospital Readmissions (16)
- (-) Hospitals (16)
- Injuries and Wounds (1)
- Medicaid (1)
- Neurological Disorders (3)
- Outcomes (1)
- Pneumonia (1)
- Provider Performance (1)
- Quality Improvement (1)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (3)
- Respiratory Conditions (2)
- Risk (1)
- Sickle Cell Disease (1)
- Surgery (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedParikh K, Lopez MA, Hall M
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Lower Child Opportunity Index (COI) has been related with increased health care use, but the relationship with rehospitalization(s) for ambulatory care sensitive conditions (ACSC) is not known. The purpose of this multicenter retrospective cohort study was to determine the relationship between COI and ACSC rehospitalizations. 184,478 children ages 0 to 17 years with a hospital admission for ambulatory care sensitive conditions in 2017 or 2018 were included. Exposure was COI, and the primary outcome was rehospitalization within 1 year of index admission for ACSC. Of hospitalizations, 28.3% were by children from very low COI and 16.5% were by children from very high COI neighborhoods. In risk-adjusted models, ACSC rehospitalization was higher for children from very low COI than very high COI neighborhoods; any rehospitalization occurred for 18.7% from very low COI and 13.5% from very high COI neighborhoods whereas 2 or more rehospitalization occurred for 4.8% from very low COI and 3.2% from very high COI neighborhoods.
AHRQ-funded; HS024554; HS028484; HS026385.
Citation: Parikh K, Lopez MA, Hall M .
Child Opportunity Index and rehospitalization for ambulatory care sensitive conditions at US children's hospitals.
Hosp Pediatr 2023 Nov; 13(11):1028-37. doi: 10.1542/hpeds.2023-007279..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals, Ambulatory Care and Surgery
Congdon M, Rauch B, Carroll B
Opportunities for diagnostic improvement among pediatric hospital readmissions.
The purpose of this retrospective cohort study was to: 1) identify and describe diagnostic errors, termed "missed opportunities for improving diagnosis" (MOIDs) in general pediatric patients who experienced hospital readmission, 2) outline improvement opportunities, and 3) explore factors associated with increased risk of MOID. The researchers included unplanned readmissions within 15 days of discharge from a freestanding children's hospital between October 2018 and September 2020. Health records were reviewed and discussed by practicing inpatient physicians to identify MOIDs using SaferDx, an established instrument. MOIDs were evaluated using a diagnostic-specific tool to identify improvement opportunities within the diagnostic process. The study found that MOIDs were identified in 6.3% of 348 readmissions. Opportunities for improvement included: delay in considering the correct diagnosis (50%) and failure to order needed test (45%). Patients with MOIDs were older than patients without MOIDs but similar in gender, primary language, race, ethnicity, and insurance type. The researchers did not identify conditions related with higher risk of MOID. Lower respiratory tract infections accounted for 26% of admission diagnoses but only 1 (4.5%) case of MOID.
AHRQ-funded; HS028682.
Citation: Congdon M, Rauch B, Carroll B .
Opportunities for diagnostic improvement among pediatric hospital readmissions.
Hosp Pediatr 2023 Jul; 13(7):563-71. doi: 10.1542/hpeds.2023-007157..
Keywords: Children/Adolescents, Diagnostic Safety and Quality, Hospitals, Hospital Readmissions
Gay JC, Teufel RJ, Peltz A
Variation in condition-specific readmission rates across US children's hospitals.
This retrospective cohort study examined variation in condition-specific readmission rates across US children’s hospitals. The authors looked at 49 US children’s hospitals in the Pediatric Health Information System in 2017. They ranked the highest volume conditions by rate variation (RV, interquartile range divided by the median) for each condition across hospitals. The sample included 811,434 index hospitalizations with 6.2% 30-day readmissions. The RV across hospitals/conditions was between 0 and 2.8 with a median of 0.7. Common reasons for admission had low RVs across hospitals, including bronchiolitis, seizure, and asthma. They identified 33 conditions with high variation in readmission rates across hospitals, which accounted for 18% of all discharges and 11% of all pediatric readmissions.
AHRQ-funded; K08-HS024735.
Citation: Gay JC, Teufel RJ, Peltz A .
Variation in condition-specific readmission rates across US children's hospitals.
Acad Pediatr 2022 Jul;22(5):797-805. doi: 10.1016/j.acap.2022.01.007..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals
Berry JG, Difazio RL, Melvin P
Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions.
This study assessed how co-occurring conditions influence recovery after hip reconstruction surgery in children with neurological complex chronic conditions (CCCs). This retrospective analysis of 4058 children age 4 years or older was conducted from 2015 to 2018 in 49 children’s hospitals. The presence of CCCs was assessed using the AHRQ Chronic Condition Indicator system. Outcomes looked for included postoperative hospital length of stay (LOS), 30 -day readmission rates, and median hospital costs. The most common co-occurring conditions were digestive (60.1%) and respiratory (37.9%). Median LOS increased 67% as co-existing conditions increased from one to four or more. Median hospital costs increased 41% and readmission rates increased 250%. Malnutrition was associated with the greatest increase in postoperative hospital use.
AHRQ-funded; HS024453.
Citation: Berry JG, Difazio RL, Melvin P .
Hospital resource use after hip reconstruction surgery in children with neurological complex chronic conditions.
Dev Med Child Neurol 2021 Feb;63(2):204-10. doi: 10.1111/dmcn.14712..
Keywords: Children/Adolescents, Chronic Conditions, Surgery, Hospital Readmissions, Hospitals, Neurological Disorders
Synhorst DC, Hall M, Harris M
Hospital observation status and readmission rates.
In several states, payers penalize hospitals when an inpatient readmission follows an inpatient stay. Observation stays are typically excluded from readmission calculations. Previous studies suggest inconsistent use of observation designations across hospitals. In this study, the investigators sought to describe variation in observation stays and examine the impact of inclusion of observation stays on readmission metrics.
AHRQ-funded; HS024735.
Citation: Synhorst DC, Hall M, Harris M .
Hospital observation status and readmission rates.
Pediatrics 2020 Nov;146(5). doi: 10.1542/peds.2020-003954..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitalization, Hospitals
Steuart R, Tan R, Melink K
Discharge before return to respiratory baseline in children with neurologic impairment.
Children with neurologic impairment (NI) are commonly hospitalized with acute respiratory infections (ARI). These children frequently require respiratory support at baseline and are often discharged before return to respiratory baseline. The purpose of this study was to determine if discharge before return to respiratory baseline was associated with reutilization among children with NI hospitalized with ARI.
AHRQ-funded; HS025138.
Citation: Steuart R, Tan R, Melink K .
Discharge before return to respiratory baseline in children with neurologic impairment.
J Hosp Med 2020 Sep;15(9):531-37. doi: 10.12788/jhm.3394..
Keywords: Children/Adolescents, Neurological Disorders, Respiratory Conditions, Hospital Readmissions, Hospital Discharge, Hospitals
Bucholz EM,, Schuster MA, Toomey SL
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
This study examined trends in 30-day readmission rates for Medicaid and privately insured pediatric patients from 2010 to 2017. The HCUP Nationwide Readmissions Database was used to compare hospital-level risk-adjusted readmission rates. Higher readmission rates were found for Medicaid beneficiaires compared to privately insured pediatric patients during the time period.
AHRQ-funded; HS020513; HS025299.
Citation: Bucholz EM,, Schuster MA, Toomey SL .
Trends in 30-day readmission for Medicaid and privately insured pediatric patients: 2010-2017.
Pediatrics 2020 Aug;146(2). doi: 10.1542/peds.2020-0270..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Health Insurance, Medicaid, Hospitals
Auger KA, Harris JM, Gay JC
Progress (?) toward reducing pediatric readmissions.
Investigators sought to determine if pediatric readmission rates have changed over time. Using data from the Inpatient Essentials Database, they found that both all-cause and potentially preventable readmission rates have remained unchanged over six years in spite of significant national efforts to reduce pediatric readmissions.
AHRQ-funded; HS024735.
Citation: Auger KA, Harris JM, Gay JC .
Progress (?) toward reducing pediatric readmissions.
J Hosp Med 2019 Oct;14(10):618-21. doi: 10.12788/jhm.3210..
Keywords: Children/Adolescents, Hospital Readmissions, Hospitals
Montalbano A, Quinonez RA, Hall M
Achievable benchmarks of care for pediatric readmissions.
This study’s objective was to calculate mean readmission rates and the Achievable Benchmarks of Care (ABCs) for pediatric diagnoses by different hospital types: metropolitan teaching, metropolitan nonteaching, and nonmetropolitan hospitals. The authors used a cross-sectional retrospective study of 30-day, all-cause same-hospital readmission of patients less than 18 years of age using the 2014 HCUP National Readmission Database. They calculated mean readmission and corresponding ABCs for the 17 most common readmission diagnosis. They found that sickle cell disease (SCD), bipolar and major depressive disorders were the most common reasons for readmission.
AHRQ-funded; HS024554.
Citation: Montalbano A, Quinonez RA, Hall M .
Achievable benchmarks of care for pediatric readmissions.
J Hosp Med 2019 Sep;14(9):534-40. doi: 10.12788/jhm.3201..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitals, Quality of Care
Auger KA, Shah SS, Huang B
Discharge medical complexity, change in medical complexity and pediatric 30-day readmission.
Investigators conducted a five-year retrospective, case-control study of pediatric hospitalizations at a tertiary care children's hospital and estimated odds of 30-day unplanned readmission using adjusted conditional logistic regression. They found that polypharmacy and use of technology at discharge pose a substantial readmission risk for children, but added technology and new complex chronic conditions do not increase risk when accounting for length of stay.
AHRQ-funded; HS204735.
Citation: Auger KA, Shah SS, Huang B .
Discharge medical complexity, change in medical complexity and pediatric 30-day readmission.
J Hosp Med 2019 Aug;14(8):474-81. doi: 10.12788/jhm.3222..
Keywords: Children/Adolescents, Chronic Conditions, Hospital Readmissions, Hospitalization, Hospitals
Statile AM, White CM, Sucharew HJ
Comparison of parent report with administrative data to identify pediatric reutilization following hospital discharge.
Healthcare providers rely on historical data reported by parents to make medical decisions. The Hospital to Home Outcomes (H2O) trial assessed the effects of a onetime home nurse visit following pediatric hospitalization for common conditions. In this study, the investigators sought to compare parent recall of reutilization events two weeks after discharge with administrative records.
AHRQ-funded; HS024735.
Citation: Statile AM, White CM, Sucharew HJ .
Comparison of parent report with administrative data to identify pediatric reutilization following hospital discharge.
J Hosp Med 2019 Jul;14(7):411-14. doi: 10.12788/jhm.3200..
Keywords: Children/Adolescents, Caregiving, Hospital Discharge, Hospital Readmissions, Hospitals
Markham JL, Richardson T, Hall M
Association of weekend admission and weekend discharge with length of stay and 30-day readmission in children's hospitals.
Worse outcomes among adults presenting for/receiving care on weekends (ie, "the weekend effect") have been observed for many diseases. However, little is known about the overall impact of the weekend effect in hospitalized children. The purpose of this study was to determine the association between 1.) weekend admission and length of stay (LOS) and 2.) weekend discharge and 30-day all-cause readmission.
AHRQ-funded; HS024735.
Citation: Markham JL, Richardson T, Hall M .
Association of weekend admission and weekend discharge with length of stay and 30-day readmission in children's hospitals.
J Hosp Med 2019 Feb;14(2):75-82. doi: 10.12788/jhm.3085..
Keywords: Children/Adolescents, Hospitals, Hospital Readmissions, Hospital Discharge, Hospitalization
Heslin KC, Owens PL, Simpson LA
AHRQ Author: Heslin KC Owens PL
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
The authors describe trends in unplanned 30-day all-condition hospital readmissions for children aged 1 to 17 years between 2009 and 2014. Using HCUP data, they found that the rate of readmission was essentially stable between 2009 and 2014. In 2009, the most common reason for readmission was sickle cell anemia, whereas in 2014 the most common reason was epilepsy. Pneumonia fell from the second to the sixth most common reason for readmission over this period. The authors suggest that their study provides a baseline assessment for examining trends in 30-day unplanned pediatric readmissions, an important quality metric as the provisions of the Children's Health Insurance Program Reauthorization Act and the Affordable Care Act are changed and implemented in the future.
AHRQ-authored.
Citation: Heslin KC, Owens PL, Simpson LA .
Annual report on health care for children and youth in the united states: focus on 30-day unplanned inpatient readmissions, 2009 to 2014.
Acad Pediatr 2018 Nov - Dec;18(8):857-72. doi: 10.1016/j.acap.2018.06.006..
Keywords: Healthcare Cost and Utilization Project (HCUP), Children/Adolescents, Hospital Readmissions, Hospitalization, Hospitals, Sickle Cell Disease, Pneumonia, Neurological Disorders
Kaiser SV, Lam R, Joseph GB
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
Researcher sought to determine if a National Quality Forum (NQF)-endorsed measure for pediatric lower respiratory illness (LRI) 30-day readmission rates can meaningfully identify high- and low-performing hospitals. Subjects were children with LRI (bronchiolitis, influenza, or pneumonia as primary diagnosis, or with an LRI as a secondary diagnosis with a primary diagnosis of respiratory failure, sepsis, bacteremia, or asthma) from all hospital admissions in California from 2012 to 2014. The researchers were unable to identify meaningful variation in hospital performance without broadening the metric definition and merging multiple years of data. They recommend that utilizers of pediatric-quality measures consider modifying metrics to better evaluate the quality of pediatric care at low-volume hospitals.
AHRQ-funded; HS024385; HS022835; HS024592; HS025297.
Citation: Kaiser SV, Lam R, Joseph GB .
Limitations of using pediatric respiratory illness readmissions to compare hospital performance.
J Hosp Med 2018 Nov;13(11):737-42. doi: 10.12788/jhm.2988..
Keywords: Children/Adolescents, Respiratory Conditions, Provider Performance, Hospital Readmissions, Hospitals, Quality Indicators (QIs), Quality Measures, Quality of Care, Quality Improvement
Sills MR, Macy ML, Kocher KE
Return visit admissions may not indicate quality of emergency department care for children.
The goal of this retrospective analysis was to test the hypothesis that in-hospital outcomes are worse among children admitted during a return ED visit than among those admitted during an index visit. Children who were hospitalized in Florida and New York hospitals during a return visit within 7 days were classified as "ED return admissions" or "readmissions"; in-hospital outcomes for ED return admissions and readmissions were compared to "index admissions without return admission". The results indicate that children who are initially discharged from the ED and then have a return admission had lower severity but similar cost in comparison with children who experienced an index admission without a return admission. The authors conclude that this suggests that ED return visit admissions do not involve worse outcomes than index admissions.
AHRQ-funded; HS024160; HS016418.
Citation: Sills MR, Macy ML, Kocher KE .
Return visit admissions may not indicate quality of emergency department care for children.
Acad Emerg Med 2018 Mar;25(3):283-92. doi: 10.1111/acem.13324..
Keywords: Children/Adolescents, Emergency Department, Hospital Discharge, Hospital Readmissions, Hospitals, Quality of Care, Outcomes
McLeod L, Flynn J, Erickson M
Variation in 60-day readmission for surgical-site infections (SSIs) and reoperation following spinal fusion operations for neuromuscular scoliosis.
The purpose of this study was to examine variation in hospital performance based on risk-standardized 60-day readmission rates for surgical-site infection (SSIs) and reoperation across 39 US Children's Hospitals. It found that reoperations were associated with an SSI in 70 percent of cases. Across hospitals, SSI and reoperation rates ranged from 1 percent to 11 percent and 1 percent to 12 percent, respectively.
AHRQ-funded; HS022198.
Citation: McLeod L, Flynn J, Erickson M .
Variation in 60-day readmission for surgical-site infections (SSIs) and reoperation following spinal fusion operations for neuromuscular scoliosis.
J Pediatr Orthop 2016 Sep;36(6):634-9. doi: 10.1097/bpo.0000000000000495.
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Keywords: Children/Adolescents, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Hospital Readmissions, Hospitals, Risk