299 - Comparing Readmission Rate and Length of Stay for Young Adults with Complex Chronic Diseases between Children's and non-Children's Hospitals

Poster Number: 299
Publication Number: 299.1468

Background: Adolescents and young adults (AYA) with complex chronic diseases (CCDs) experience an increase in hospital readmissions during the transition from adolescence to adulthood. Prior studies have not examined whether rates of readmission differ based on whether care was initially received at a children’s hospital (CH) vs non-children’s hospital (non-CH).

Objective: To measure associations between hospital type and readmission rates and index admission length of stay (LOS) among AYA with selected CCDs.

Design/Methods: We performed a retrospective cross-sectional study of the 2017 AHRQ HCUP State Inpatient Database (SID) from 9 states meeting data availability and accuracy standards: AR, FL, MA, MD, MS, NY, UT, WA, WI. We included patients 12-25 years old with an ICD-10 code for five CCDs: cystic fibrosis (CF), sickle cell disease (SCD), spina bifida (SB), inflammatory bowel disease (IBD), or diabetes mellitus (DM). Index hospitalizations were categorized by hospital type (CH vs non-CH), CCD, and age group (12-17, 18-21, 22-25). We utilized the Pediatric All-Condition Readmission (PACR) measure to exclude planned readmissions and calculate case-mix adjusted 30-day readmission rates. Differences in index admission LOS between CH and non-CH were compared using Medicare Severity Diagnosis Related Group (MS-DRG) relative weight adjustment. We used generalized estimating equations to assess the association of index hospital type with readmissions and length of stay, adjusting for age and CMS relative weights and clustering on hospital.

Results: Index admission volumes were higher at non-CH (N = 19,884 (51%)) than CH (N = 19,118 (49%)) and there were significant differences in all demographic variables (Table 1). Overall odds of readmission increased with age and were significantly lower at CHs for CF (OR: 0.51, 95% CI: 0.33-0.79), SCD (OR: 0.82, 95% CI: 0.68-0.98), and DM (OR: 0.70, 95% CI: 0.58-0.84; Fig. 1). Compared to non-CH, patients with CF (RR: 1.31, 95% CI: 1.07-1.62), SCD (RR: 1.12, 95% CI: 1.05-1.19), and IBD (RR: 1.13, 95% CI: 1.07-1.19) admitted to CH experienced longer LOS (Table 2). These findings were most pronounced for 22–25-year-old patients with CF and SCD, and patients < 21 years with IBD.

Conclusion(s): Among patients with CF, SCD, and DM ages 12-25 years old, index hospitalization at a CH is associated with lower readmission rates. This comes at the cost of higher LOS for those with CF and SCD. This study supports policy and quality improvement efforts aimed at improving transitions of care for young adults.