Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations

Health Serv Res. 2020 Apr;55(2):277-287. doi: 10.1111/1475-6773.13269. Epub 2020 Feb 9.

Abstract

Objective: To determine the correlation between hospital 30-day risk-standardized readmission rates (RSRRs) in elderly adults and those in nonelderly adults and children.

Data sources/study setting: US hospitals (n = 1760 hospitals admitting adult patients and 235 hospitals admitting both adult and pediatric patients) in the 2013-2014 Nationwide Readmissions Database.

Study design: Cross-sectional analysis comparing 30-day RSRRs for elderly adult (≥65 years), middle-aged adult (40-64 years), young adult (18-39 years), and pediatric (1-17 years) patients.

Principal findings: Hospital elderly adult RSRRs were strongly correlated with middle-aged adult RSRRs (Pearson R2 .69 [95% confidence interval (CI) 0.66-0.71]), moderately correlated with young adult RSRRs (Pearson R2 .44 [95% CI 0.40-0.47]), and weakly correlated with pediatric RSRRs (Pearson R2 .28 [95% CI 0.17-0.38]). Nearly identical findings were observed with measures of interquartile agreement and Kappa statistics. This stepwise relationship between age and strength of correlation was consistent across every hospital characteristic.

Conclusions: Hospital readmission rates in elderly adults, which are currently used for public reporting and hospital comparisons, may reflect broader hospital readmission performance in middle-aged and young adult populations; however, they are not reflective of hospital performance in pediatric populations.

Keywords: age; readmission.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Guidelines as Topic*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medicaid / standards*
  • Medicare / standards*
  • Medicare / statistics & numerical data
  • Middle Aged
  • Patient Readmission / standards*
  • Patient Readmission / statistics & numerical data*
  • Quality Indicators, Health Care / standards*
  • Quality Indicators, Health Care / statistics & numerical data*
  • United States
  • Young Adult