To Readmission and Beyond

* Abbreviations: EHR — : electronic health record LOS — : length of stay NRD — : Nationwide Readmissions Database The study of pediatric readmission has received significant attention since 2012, when the Centers for Medicare and Medicaid Services signaled the possibility of financial risk to hospitals based on pediatric 30-day readmission rates.1 We have since learned that readmission rates appear to depend on many factors,2,3 the importance of which vary by age and medical condition,4–6 surgical procedure,7–9 the presence of chronic or complex care needs,10,11 social determinants of health,12,13 access to care,14–16 adherence to evidence-based practice,17–19 and patient–health system interactions, particularly those involving transitions of care and care coordination.20–22 Identifying prevention targets has been hampered by limited study generalizability and the paucity of preventable phenomena.23 In fact, it has been estimated that preventable readmissions represent <2% of all pediatric admissions.24 Whereas a short length of stay (LOS) has been associated with an increased risk of readmission in certain adult patient populations,25 a longer LOS is not necessarily associated with fewer readmissions, and there remains little evidence to support any such association for pediatric care. In this month’s issue of Pediatrics , Markham et al … Address correspondence to Paul T. Rosenau, MD, MS, Department of Pediatrics, Larner College of Medicine, The University of Vermont, 89 Beaumont Ave, Given CY S259, Burlington, VT 05405. E-mail: paul.rosenau{at}uvmhealth.org