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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
4274.0: Tuesday, December 13, 2005 - Board 3

Abstract #110440

Risk factors and cost of hospital readmission after discharge from the neonatal intensive care nursery

Scott A. Lorch, MD, MSCE1, Gabriel J. Escobar, MD2, Susan Bakewell-Sachs, PhD, RN3, Barbara Medoff-Cooper, PhD, RN4, and Jeffrey H. Silber, MD, PhD1. (1) Pediatrics, The Children's Hospital of Philadelphia, 3535 Market Street, Suite 1029, Philadelphia, PA 19104, 215-590-5635, lorch@email.chop.edu, (2) Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612, (3) School of Nursing, The College of New Jersey, 2000 Pennington Rd, PO Box 7718, Ewing, NJ 08628-0718, (4) School of Nursing, University of Pennsylvania, 420 Guardian Drive, Philadelphia, PA 19104-6096

Background: Premature infants with bronchopulmonary dysplasia (BPD) have an increased risk of hospital readmission within one year of discharge, but other risk factors and costs are unknown. Methods: All surviving infants born £32 weeks gestational age (GA) at 6 Northern California Kaiser Permanente hospitals between 1998 and 2001 were studied (N=892) along with a random sample of 541 infants of 33-34 weeks GA. We excluded infants with congenital anomalies, home ventilation, VP shunt, or who were lost to follow-up. The cost of a readmission was calculated from all personnel and non-personnel resources in 2001 dollars. Logit and Cox regression models determined prognostic factors for readmission and time to readmission after discharge. Results: 277 infants (19.3%) had a total of 419 readmissions within one year of discharge. The median cost of these readmissions was $879.91 per readmitted patient (interquartile range $427.32-$1875.51) at a total cost of $819,800. Compared to infants of 34 weeks GA, infants < 30 weeks GA were more likely to be readmitted (odds ratio (OR) for infants £26 weeks 3.77, 95% CI 2.03-7.00; OR for infants 27-30 weeks GA 1.86, 95% CI 1.24-2.80). BPD (OR 1.69, 95% CI 1.07-2.68), necrotizing enterocolitis (OR 3.91, 95% CI 1.24-12.27), and male sex (OR 1.63, 95% CI 1.23-2.16) were also associated with both an increased risk and shorter time to readmission. Conclusions: BPD, necrotizing enterocolitis, and younger GA are strongly associated with increased odds of readmission. Programs to identify high-risk infants and reduce these readmissions would result in significant cost savings.

Learning Objectives:

Keywords: Infant Health, Cost Issues

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Infant and Child Health: Policy and Practice

The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA