PURPOSE: To describe recurrent admissions in a cohort of complex
chronic patients at a specialty children's hospital, identify factors that
contribute to multiple admissions, and test the hypothesis that risk factors
predict patterns of readmissions within specified time intervals.
METHODS: Retrospective cohort analysis of patients admitted to a specialty
children's hospital during calendar year 2006 followed through 2011.
Administrative and medical record abstracted data were analyzed by the total
number of recurrent admissions and by readmissions with 7, 30 and 90 days at
any point during the five year study period.
RESULTS: One thousand two hundred and twenty-nine
patients with 2295 inpatient admissions were
examined. %467
Four hundred and sixty-seven
patients (38%) experienced at least one additional
inpatient admission at any time during the study period. Eight variables
were significant risk factors for subsequent admission at any time during
the study period: indwelling technology, mobility support, critical care
consultation, medical (vs. surgical) admission, mean LOS across all
admissions, number of scheduled medications at discharge, insurance on index
admission, and gross charges on index admission.
Presence of indwelling technology, increasing numbers of scheduled
medications at discharge and Nervous System APR-DRG diagnoses were
significant factors predicting readmission within 7, 30, and 90 day
intervals.
CONCLUSIONS: Within this population of complex chronic patients
risk factors were identified that predict vulnerability to recurrent
admissions suggesting that further research is needed to address a unique
subset of complex chronic patients and the complement of systems organized
to provide health care delivery services for them.
