Impact of Discharge Components on Readmission Rates for Children Hospitalized with Asthma

Abstract

Objectives: To describe hospital-based asthma-specific discharge components at children's hospitals and determine the association of these discharge components with pediatric asthma readmission rates.

Study design: This is a multicenter retrospective cohort study of pediatric asthma hospitalizations in 2015 at children's hospitals participating in the Pediatric Health Information System. Children ages 5 to 17 years were included. An electronic survey assessing 13 asthma-specific discharge components was sent to quality leaders at all 49 hospitals. Correlations of combinations of asthma-specific discharge components and adjusted readmission rates were calculated.

Results: The survey response rate was 92% (45 of 49 hospitals). Thirty-day and 3-month adjusted readmission rates varied across hospitals, ranging from 1.9% to 3.9% for 30-day readmissions and 5.7% to 9.1% for 3-month readmissions. No individual or combination discharge components were associated with lower 30-day adjusted readmission rates. The only single-component significantly associated with a lower rate of readmission at 3 months was having comprehensive content of education (P < .029). Increasing intensity of discharge components in bundles was associated with reduced adjusted 3-month readmission rates, but this did not reach statistical significance. This was seen in a 2-discharge component bundle including content of education and communication with the primary medical doctor, as well as a 3-discharge component bundle, which included content of education, medications in-hand, and home-based environmental mitigation.

Conclusions: Children's hospitals demonstrate a range of asthma-specific discharge components. Although we found no significant associations for specific hospital-level discharge components and asthma readmission rates at 30 days, certain combinations of discharge components may support hospitals to reduce healthcare utilization at 3 months.

Keywords: asthma; chronic; discharge; inpatient; readmissions; transition.

Copyright © 2017 Elsevier Inc. All rights reserved.

Figures

Figure 1.

Asthma-specific discharge components at surveyed hospitals by intensity. Scaled representation of discharge practice intensity across all surveyed hospitals.

Figure 2.

Association of discharge bundles by intensity with reduction in 3-month adjusted readmission rates. Relationship of discharge bundles with 3-month readmission rate where each circle represents a single surveyed hospital. X-axis represents discharge component intensity because each component was scored as 1 (low intensity) to 3 (high intensity), so range for 2-discharge component is 2 to 6 and range for 3-discharge component is 3 to 9.