Influence of Geographic Access on Surgical Center Readmissions After Index Congenital Heart Surgery
To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery. Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Heal...
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| Veröffentlicht in: | The Journal of pediatrics Jg. 234; S. 195 - 204.e3 |
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| Format: | Journal Article |
| Sprache: | Englisch |
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United States
Elsevier Inc
01.07.2021
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| ISSN: | 0022-3476, 1097-6833, 1097-6833 |
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| Abstract | To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.
Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural–urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression.
Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days.
Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population. |
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| AbstractList | To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.OBJECTIVETo assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression.STUDY DESIGNChildren <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression.Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days.RESULTSAmong 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days.Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population.CONCLUSIONSGeographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population. To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery. Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural–urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression. Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days. Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population. |
| Author | Yoo, Minkyoung Yamauchi, Melissa LuAnn Minich, L. Nelson, Richard Pinto, Nelangi M. Wilkes, Jacob Floyd, Alisha VanDerslice, James |
| AuthorAffiliation | 2 Department of Economics and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT 5 Division of Epidemiology, Department of Internal Medicine and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT 4 Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT 3 Department of Pediatric Analytics, Intermountain Healthcare, Salt Lake City, UT 1 Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT |
| AuthorAffiliation_xml | – name: 2 Department of Economics and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT – name: 3 Department of Pediatric Analytics, Intermountain Healthcare, Salt Lake City, UT – name: 4 Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT – name: 1 Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT – name: 5 Division of Epidemiology, Department of Internal Medicine and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT |
| Author_xml | – sequence: 1 givenname: Nelangi M. surname: Pinto fullname: Pinto, Nelangi M. email: nelangi.pinto@hsc.utah.edu organization: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 2 givenname: L. surname: LuAnn Minich fullname: LuAnn Minich, L. organization: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 3 givenname: Minkyoung surname: Yoo fullname: Yoo, Minkyoung organization: Department of Economics and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT – sequence: 4 givenname: Alisha surname: Floyd fullname: Floyd, Alisha organization: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 5 givenname: Jacob surname: Wilkes fullname: Wilkes, Jacob organization: Department of Pediatric Analytics, Intermountain Healthcare, Salt Lake City, UT – sequence: 6 givenname: James orcidid: 0000-0003-0008-6353 surname: VanDerslice fullname: VanDerslice, James organization: Division of Public Health, Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT – sequence: 7 givenname: Melissa surname: Yamauchi fullname: Yamauchi, Melissa organization: Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT – sequence: 8 givenname: Richard orcidid: 0000-0002-4441-7460 surname: Nelson fullname: Nelson, Richard organization: Division of Epidemiology, Department of Internal Medicine and Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT |
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| Snippet | To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.
Children <6 years old... To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery.OBJECTIVETo assess the... |
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| SubjectTerms | Child Child, Preschool Female Health Care Costs - statistics & numerical data Health Services Accessibility - economics Health Services Accessibility - statistics & numerical data Heart Defects, Congenital - economics Heart Defects, Congenital - surgery Hospitals, Pediatric - economics Hospitals, Pediatric - supply & distribution Humans Infant Infant, Newborn Longitudinal Studies Male Patient Readmission - economics Patient Readmission - statistics & numerical data Regression Analysis Retrospective Studies Rural Health - economics Rural Health - statistics & numerical data Rural Health Services - economics Rural Health Services - supply & distribution Tertiary Care Centers - economics Tertiary Care Centers - supply & distribution United States Urban Health - economics Urban Health - statistics & numerical data Urban Health Services - economics Urban Health Services - supply & distribution |
| Title | Influence of Geographic Access on Surgical Center Readmissions After Index Congenital Heart Surgery |
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