Suitability of elderly adult hospital readmission rates for profiling readmissions in younger adult and pediatric populations

摘要

Abstract Objective To determine the correlation between hospital 30‐day risk‐standardized readmission rates (RSRRs) in elderly adults and those in nonelderly adults and children. Data Sources/Study Setting US hospitals (n?=?1760 hospitals admitting adult patients and 235 hospitals admitting both adult and pediatric patients) in the 2013‐2014 Nationwide Readmissions Database. Study Design Cross‐sectional analysis comparing 30‐day RSRRs for elderly adult (≥65?years), middle‐aged adult (40‐64?years), young adult (18‐39?years), and pediatric (1‐17?years) patients. Principal Findings Hospital elderly adult RSRRs were strongly correlated with middle‐aged adult RSRRs (Pearson R 2 .69 [95% confidence interval (CI) 0.66‐0.71]), moderately correlated with young adult RSRRs (Pearson R 2 .44 [95% CI 0.40‐0.47]), and weakly correlated with pediatric RSRRs (Pearson R 2 .28 [95% CI 0.17‐0.38]). Nearly identical findings were observed with measures of interquartile agreement and Kappa statistics. This stepwise relationship between age and strength of correlation was consistent across every hospital characteristic. Conclusions Hospital readmission rates in elderly adults, which are currently used for public reporting and hospital comparisons, may reflect broader hospital readmission performance in middle‐aged and young adult populations; however, they are not reflective of hospital performance in pediatric populations.