One in 20 infants is admitted to the hospital during the first year of life. As frightening as it may be for families to have a child whose health condition requires hospitalization, in too many cases the experience gets worse when a relapse or problem managing the condition after discharge means their child must be re-admitted later. Babies born prematurely are among the groups of children are at highest risk of hospital readmission.
With a new grant from the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ), researchers at The Children’s Hospital of Philadelphia are working to reduce the need for pediatric readmissions by taking a population-level look at clinical factors, and an up-close look at familial and social factors, that send high-risk groups of children back to the hospital
“The long-term goal is to take this information and develop real-time predictions,” said study leader Scott Lorch, MD, MSCE, director of the Center for Perinatal and Pediatric Health Disparities Research at CHOP and associate professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. “We are looking for things that can be fed back to the clinical team to say, based on these factors, this patient has a higher than usual risk of readmission.”
First, Dr. Lorch and his team will analyze population-based national pediatric healthcare data from a large number of hospitals and outpatient centers. They aim to determine what processes and structures of care may be associated with changing readmission risk in high-risk groups. In addition to premature infants, groups involved in the study may include children with asthma and children with complex or chronic medical conditions.
Notably, their analysis will cover both inpatient and outpatient data sources to consider the full picture of what care children receive after their hospital discharge and before potential readmission.
“Inpatient and outpatient data tend to be analyzed separately,” Dr. Lorch said. “That only gives you part of the story.”
Next, over a four-year period, Dr. Lorch’s team will survey families seen at CHOP to gain insights into factors such as familial stress, support, and other social factors that may affect the risk of hospital readmission. Families’ experience and preparation may make a big difference. Premature infants, for example, often remain in the hospital for weeks or months after birth.
“During that time, parents have more of a passive role,” Dr. Lorch said. “When they take the child home, the transition can be very difficult for families who have never done this in the past. Understanding how those factors relate to the risk of readmission allows us to understand the risk and to tailor interventions to mitigate it.”
Eventually these insights could lead to keeping clinicians better informed about which patients are at higher risk before children leave the hospital, and better equipped to support those high-risk families with resources to prevent the problems they experience today.