In the Vanderbilt cohort, the final expert consensus was that 40 early readmissions (20%) were more likely preventable (ratings 4 and 5). Nearly half of these were central venous catheter infections or ventriculo-peritoneal shunt malfunctions in children with serious chronic illnesses.
Extrapolating these results, about 1.7% of all hospital admissions would have a significant degree of preventability, Dr. Gay said. In absolute terms, about 250 admissions per year, or less than one admission per day, would be preventable at the Children’s Hospital at Vanderbilt.
"With 80% of readmissions planned or likely not preventable, it seems unreasonable to believe that pediatric readmissions are associated with substandard inpatient care, calling into question the validity of an all-cause readmission rate as a quality measure," he said. "If the responsibility for pediatric readmissions is placed on the hospital, then realistic benchmarks should be established."
Dr. Gay said more data is also needed from across the country, with some of that information trickling in from the recent Pediatric Academic Societies meeting. Various investigators reported that there was no relationship between length of stay and pediatric readmissions; 30-day readmission rates were low at 2%-8% in the top 10 APR-DRG (All Patient Refined Diagnosis Related Groups) hospitals; and significant variability exists in readmission rates across hospitals for 10 of the top 30 APR-DRG index admissions.
"This may be where we need to hone our efforts," Dr. Gay said. "If there’s variability, there may be a reason for that variability that we can have an impact on."
Dr. Gay reported funding support for medical consulting for the National Association of Children’s Hospitals and Related Institutions. Dr. Hain reported no conflicts of interest.