Three-month readmission rates for children hospitalized with acute asthma fell when families received a full pre-discharge education, according to a study published in the Journal of Pediatrics. In fact, it was the only component of exit groups that was strongly associated with a decline in readmissions.
Under federal law, the Centers for Medicare and Medicaid Services offer lower reimbursement to hospitals that have low readmission rates compared to their peers, essentially a financial penalty related to clinical quality.
[Also: CDC: U.S. healthcare must improve asthma management to cut costs]
Asthma is the most common chronic lung disease of childhood, affecting approximately 6 million children in the United States, according to the Centers for Disease Control and Prevention.
Children hospitalized with asthma have about a 20% chance of returning to the hospital the following year, and individual hospital readmission rates can range from 5.7% to 9.1% at three months, depending on the patient. researchers. Although the National Institutes of Health have published evidence-based guidelines for discharge planning, there is no single, standardized asthma discharge process used in all pediatric hospitals in the United States that has an impact on 30-day readmission rates.
The authors analyzed records from a national sample of tertiary care pediatric hospitals, looking at hospital admissions of children aged 5 to 17 for acute asthma exacerbation in 2015. They characterized the frequency with which hospitals were using 13 separate components of the asthma discharge by distributing an electronic survey to quality leaders.
The 45 responding hospitals had a median of 349 asthma discharges per year, and had a median adjusted readmission rate of 2.6% at 30 days and a median adjusted readmission rate of 6.6% at three months. . The most common discharge components used for children with asthma were the presence of a dedicated educator (76%), the provision of a spacer at the discharge (67%), and communication with an attending physician ( 58%).
Aspects of discharge that help reduce readmission rates to three months included comprehensive asthma education, with specialist asthma educators; medications and devices provided to patients on discharge, such as spacers, beta-agonists, controller medications, and oral steroids; communication and scheduled appointments with an attending physician; and post-discharge activities, including home visits and referrals for environmental mitigation programs.
The authors recommended combining these strategies as much as possible to have the greatest possible impact on asthma-related readmissions.