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Maturational, comorbid, maternal and discharge domain impact on preterm rehospitalizations: a comparison of planned and unplanned rehospitalizations

Journal of Perinatology volume 36, pages 317–324 (2016)Cite this article

Subjects

Abstract

Objective:

To determine the predictive value of (1) maternal, (2) maturational, (3) comorbid and (4) discharge domains associated with preterm infant rehospitalization.

Study Design:

Retrospective, cohort study of preterm infants discharged home from a level IV neonatal intensive care unit. Rates of unplanned and planned 6-month readmissions were assessed. The four domains were modeled incrementally and separately to predict relative and combined contributions to the readmission risk.

Result:

Out of 504 infants, 5% had 30-day readmissions (22 unplanned, three planned). By 6 months, 13% were rehospitalized (52 unplanned, 15 planned). Sixty-seven infants had 96 readmission events with 30% of readmission events elective. The four domains together predicted 78% of total 1-month, all 6-month and unplanned 6-month readmissions. Discharge complexity was as predictive as comorbidity in all models.

Conclusion:

These four-domain models were more predictive than single domains. Many total readmission events were planned, suggesting parsing planned and unplanned rehospitalizations may benefit quality-improvement efforts.

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References

  1. Petrou S, Mehta Z, Hockley C, Cook-Mozaffari P, Henderson J, Goldacre M . The impact of preterm birth on hospital inpatient admissions and costs during the first 5 years of life. Pediatrics 2003; 112: 1290–1297.

    Article  Google Scholar 

  2. Escobar GJ, Joffe S, Gardner MN, Armstrong MA, Folck BF, Carpenter DM . Rehospitalization in the first two weeks after discharge from the neonatal intensive care unit. Pediatrics 1999; 104: 1–9.

    Article  Google Scholar 

  3. Ambalavanan N, Carlo WA, McDonald SA, Yao Q, Das A, Higgins RD . Identification of extremely premature infants at high risk of rehospitalization. Pediatrics 2011; 128: e1216–e1225.

    Article  Google Scholar 

  4. Ralser E, Mueller W, Haberland C, Fink FN, Gutenberger KH, Strobl R et al. Rehospitalization in the first 2 years of life in children born preterm. Acta Paediatr 2012; 101: e1–e5.

    Article  Google Scholar 

  5. Morris BH, Gard CC, Kennedy K . Rehospitalization of extremely low birth weight (ELBW) infants: are there racial/ ethnic disparities? J Perinatol 2005; 25: 656–663.

    Article  Google Scholar 

  6. Vohr BR, Yatchmink YE, Burke RT, Stephens BE, Cavanaugh EC, Alksninis B et al. Factors associated with rehospitalizations of very low birthweight infants: impact of a transition home support and education program. Early Hum Dev 2012; 88: 455–460.

    Article  Google Scholar 

  7. Martens PJ, Derksen S, Gupta S . Predictors of hospital rehospitalization of Manitoba newborns within six weeks postbirth discharge: a population-based study. Pediatrics 2004; 114: 708–713.

    Article  Google Scholar 

  8. Lamarche-Vadel A, Blondel B, Truffert P, Burguet A, Cambonie G, Selton D et al. Re-hospitalization in infants younger than 29 weeks’ gestation in the EPIPAGE cohort. Acta Paediatr 2004; 93: 1340–1345.

    Article  CAS  Google Scholar 

  9. Stephens BE, Tucker R, Vohr BR . Special health care needs of infants born at the limits of viability. Pediatrics 2010; 125: 1152–1158.

    Article  Google Scholar 

  10. Elder DE, Hagan R, Evans SF, Benninger HR, French NP . Hospital admissions in the first year of life in very preterm infants. J Paediatr Child Health 1999; 35: 145–150.

    Article  CAS  Google Scholar 

  11. Oddie SJ, Hammal D, Richmond S, Parker L . Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study. Arch Dis Child 2005; 90: 119–124.

    Article  CAS  Google Scholar 

  12. Tseng YH, Chen CW, Huang HL, Chen CC, Lee MD, Ko MC et al. Incidence of and predictors for short-term rehospitalization among preterm low-birthweight infants. Pediatr Int 2010; 52: 711–717.

    Article  Google Scholar 

  13. Paranjothy S, Dunstan F, Watkins WJ, Hyatt M, Demmler JC, Lyons RA et al. Gestational age, birth weight, and risk of respiratory hospital admission in childhood. Pediatrics 2013; 132: e1562–e1569.

    Article  Google Scholar 

  14. Chen E, Martin AD, Matthews KA . Trajectories of socioeconomic status across children’s lifetime predict health. Pediatrics 2007; 120: e297–e303.

    Article  Google Scholar 

  15. Bell EF . American Academy of Pediatrics Committee on Fetus and Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008; 122: 1119–1126.

    Article  Google Scholar 

  16. Darnall RA, Kattwinkel J, Nattie C, Robinson M . Margin of safety for discharge after apnea in preterm infants. Pediatrics 1997; 100: 795–801.

    Article  CAS  Google Scholar 

  17. Bakewell-Sachs S, Medoff-Cooper B, Escobar GJ, Silber JH, Lorch SA . Infant functional status: the timing of physiologic maturation of premature infants. Pediatrics 2009; 123: e878–e886.

    Article  Google Scholar 

  18. Amaizu N, Shulman RJ, Schanler RJ, Lau C . Maturation of oral feeding skills in preterm infants. Acta Paediatr 2008; 97: 61–67.

    Article  CAS  Google Scholar 

  19. Eichenwald EC, Blackwell M, Lloyd JS, Tran T, Wilker RE, Richardson DK . Inter-neonatal intensive care unit variation in discharge timing: influence of apnea and feeding management. Pediatrics 2001; 108: 928–933.

    Article  CAS  Google Scholar 

  20. Krumholz HM . Post-hospital syndrome—an acquired, transient condition of generalized risk. N Engl J Med 2013; 368: 100–102.

    Article  CAS  Google Scholar 

  21. Marks E . Complexity science and the readmission dilemma. JAMA Intern Med 2013; 173: 629–631.

    Article  Google Scholar 

  22. Van Walraven C, Dhalla IA, Bell C, Etchells E, Stiell IG, Zarnke K et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ 2010; 182: 551–557.

    Article  Google Scholar 

  23. Donzé J, Aujesky D, Williams D, Schnipper JL . Potentially avoidable 30-day hospital readmissions in medical patients: derivation and validation of a prediction model. JAMA Intern Med 2013; 173: 632–638.

    Article  Google Scholar 

  24. Garrison GM, Mansukhani MP, Bohn B . Predictors of thirty-day readmission among hospitalized family medicine patients. J Am Board Fam Med 2013; 26: 71–77.

    Article  Google Scholar 

  25. Smith VC, Young S, Pursley DM, McCormick MC, Zupancic JA . Are families prepared for discharge from the NICU? J Perinatol 2009; 29: 623–629.

    Article  CAS  Google Scholar 

  26. Smith VC, Hwang SS, Dukhovny D, Young S, Pursley DM . Neonatal intensive care unit discharge preparation, family readiness, and infant outcomes: connecting the dots. J Perinatol 2013; 33: 415–421.

    Article  CAS  Google Scholar 

  27. Lindenauer PK, Lagu T, Rothberg MB, Avrunin J, Pekow PS, Wang Y et al. Income inequality and 30-day outcomes after acute myocardial infarction, heart failure, and pneumonia: retrospective cohort study. BMJ 2013; 346: f521.

    Article  Google Scholar 

  28. Bratzler DW, Normand ST, Wang Y, O’Donnell WJ, Metersky M, Han LF et al. An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients. PloS ONE 2011; 6: e17401.

    Article  CAS  Google Scholar 

  29. Kennan PS, Normand ST, Lin Z, Drye EE, Bhat KR, Ross JS et al. An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-causes readmission rates among patients with heart failure. Circ Cardiovasc Qual Outcomes 2008; 1: 29–37.

    Article  Google Scholar 

  30. South AP, Wessel JJ, Sberna A, Patel M, Morrow AL . Hospital rehospitalization among infants with gastroschisis. J Perinatol 2011; 31: 546–550.

    Article  CAS  Google Scholar 

  31. Centers for Medicare and Medicaid Services, Acute Inpatient Prospective Payment System. Readmissions Reduction Program. Available at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html (accessed 15 September 2015).

  32. Fenton TR . A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3: 13.

    Article  Google Scholar 

  33. Jobe AH, Bancalari E . Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001; 163: 1723–1729.

    Article  CAS  Google Scholar 

  34. Walsh MC, Kliegman RM . Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am 1986; 33: 179–201.

    Article  CAS  Google Scholar 

  35. Cotten CM, Taylor S, Stoll B, Goldberg RN, Hansen NI, Sanchez PJ et al. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009; 123: 58–66.

    Article  Google Scholar 

  36. Kuppala VS, Meinzen-Derr J, Morrow AL, Schibler KR . Prolonged initial empirical antibiotic treatment is associated with adverse outcomes in premature infants. J Pediatr 2011; 159: 720–725.

    Article  CAS  Google Scholar 

  37. Papile LA, Burstein J, Burstein R, Koffler H . Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92: 529–534.

    Article  CAS  Google Scholar 

  38. Hoffman LA, Tasota FJ, Scharfenberg C, Zullo TG, Donahoe MP . Management of patients in the intensive care unit: comparison via work sampling analysis of an acute care nurse practitioner and physicians in training. Am J Crit Care 2003; 12: 436–443.

    PubMed  Google Scholar 

  39. Cleves MA . From the help desk: Comparing areas under receiver operating characteristic curves from two or more probit or logit models. Stata J 2002; 2: 301–313.

    Article  Google Scholar 

  40. Pepe Margaret S . The Statistical Evaluation of Medical Tests for Classification and Prediction. Oxford University Press: New York, 2003.

    Google Scholar 

  41. Harrell FE, Lee KL, Mark DB . Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996; 15: 361–387.

    Article  Google Scholar 

  42. Escobar GJ, Greene JD, Hulac P, Kincannon E, Bischoff K, Gardner MN et al. Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 2005; 90: 125–131.

    Article  CAS  Google Scholar 

  43. Alverson BK, O’Callaghan J . Hospital readmission: quality indicator or statistical inevitability? Pediatrics 2013; 132: 569–570.

    Article  Google Scholar 

  44. Hansen LO, Young RS, Hinami K, Leung A, Williams MV . Interventions to reduce 30-day rehospitalization: a systematic review. Ann Intern Med 2011; 155: 520–528.

    Article  Google Scholar 

  45. Fontanarosa PB, McNutt R . Revisiting hospital readmissions. JAMA 2013; 309: 398–400.

    Article  CAS  Google Scholar 

  46. Stang AS, Straus SE, Crotts J, Johnson DW, Guttmann A . Quality indicators for high acuity pediatric conditions. Pediatrics 2013; 132: 752–762.

    Article  Google Scholar 

  47. Gäddlin PO, Finnström O, Hellgren K, Leijon I . Hospital readmissions and morbidity in a fifteen-year follow-up of very low birthweight children in Southeast Sweden. Acta Pediatr 2007; 96: 499–505.

    Article  Google Scholar 

  48. Hack M, DeMonterice D, Merkatz IR, Jones P, Fanaroff AA . Rehospitalization of the very-low-birth-weight infant: a continuum of perinatal and environmental morbidity. Am J Dis Child 1981; 135: 263–266.

    Article  CAS  Google Scholar 

  49. U.S. Department of Health and Human Services Health Resources and Services Administration. The Maternal and Child Health Federal-State Partnership: New York. Available at: https://mchdata.hrsa.gov/tvisreports/Snapshot/snapshot.aspx?statecode=NY (accesse 15 September 2015).

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Acknowledgements

We thank Sergio Golombek, MD, MPH, Joshua C Brumberg, PhD and Stephan Brumberg, EdD for helpful discussions and comments on the manuscript. We also thank Yin Tong, BS, Janine Lebofwsky, BS and Sumith Roy, MD for assistance with data collection.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Newborn Medicine, Maria Fareri Children's Hospital at Westchester Medical Center, New York Medical College, Valhalla, NY, USA

    S Schell, J S Kase, B Parvez, S I Shah & H L Brumberg

  2. School of Aging Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA

    H Meng

  3. Department of Public Health, Brody School of Medicine, Greenville, NC, USA

    M Grzybowski

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  1. S Schell
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Correspondence to H L Brumberg.

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Schell, S., Kase, J., Parvez, B. et al. Maturational, comorbid, maternal and discharge domain impact on preterm rehospitalizations: a comparison of planned and unplanned rehospitalizations. J Perinatol 36, 317–324 (2016). https://doi.org/10.1038/jp.2015.194

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