Factors influencing recurrent admissions among children with disabilities in a specialty children's hospital

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. 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.