The Association of the Childhood Opportunity Index on Pediatric Readmissions and Emergency Department Revisits

Journal article in Academic Pediatrics using the Child Opportunity Index to to measure the relationship between social determinants of health and pediatric hospital readmissions and emergency room revisits. Finds that children in low opportunity areas have a greater chance of revisiting the emergency room or being hospitalized after an initial encounter. Results suggest that a broader approach, including policy and system-level change, is needed to effectively reduce readmissions and ED revisits

The Effects of Traditional Fermented Beverages on Ethanol, Ethyl Glucuronide and Ethyl Sulphate Levels

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Hospital Observation Status and Readmission Rates

BACKGROUND: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. We sought to describe variation in observation stays and examine the impact of inclusion of observation stays on readmission metrics.METHODS:We conducted a retrospective cohort study of hospitalizations at 50 hospitals contributing to the Pediatric Health Information System database from January 1, 2018, to December 31, 2018. We examined prevalence of observation use across hospitals and described changes to inpatient readmission rates with higher observation use. We described 30-day inpatient-only readmission rates and ranked hospitals against peer institutions. Finally, we included observation encounters into the calculation of readmission rates and evaluated hospitals’ change in readmission ranking.RESULTS:Most hospitals (n = 44; 88%) used observation status, with high variation in use across hospitals (0%–53%). Readmission rate after index inpatient stay (6.8%) was higher than readmission after an index observation stay (4.4%), and higher observation use by hospital was associated with higher inpatient-only readmission rates. When compared with peers, hospital readmission rank changed with observation inclusion (60% moving at least 1 quintile).CONCLUSIONS:The use of observation status is variable among children’s hospitals. Hospitals that more liberally apply observation status perform worse on the current inpatient-to-inpatient readmission metric, and inclusion of observation stays in the calculation of readmission rates significantly affected hospital performance compared with peer institutions. Consideration should be given to include all admission types for readmission rate calculation.</jats:sec