Pediatric asthma readmissions occur at rates of 30% or higher annually and many of these are potentially preventable. Contributing factors to adult and pediatric readmissions include patient characteristics, inpatient and outpatient management, and inpatient structural and process factors around transitions of care. However, very few interventions have been evaluated in the literature addressing these factors in pediatric asthma or in any other pediatric disease. This career development award seeks to address these gaps in the literature through the following specific aims:
Aim 1 : To develop and validate a 30 day risk adjustment model for pediatric asthma readmissions. This includes the development of a risk adjustment model using a large statewide administrative database, providing a novel contribution as it will identify readmissions to all hospitals (tertiary care and community, high volume and low volume). It also allows us to identify high and low performing hospitals for focus in our next aim.
Aim 2 : To use qualitative methods to identify hospital-level interventions that may be associated with lower (or higher) pediatric asthma readmissions rates. Qualitative methods will enable us to draw out types of interventions and factors contributing to readmissions not yet described in the literature.
Aim 3 : To determine the association between the presence of hospital-level interventions to prevent asthma readmissions and the risk adjusted rate of asthma readmissions. In this aim, we will develop and administer a quantitative survey to assess for the presence of interventions to prevent or decrease pediatric asthma readmissions, based on a previous review of the literature on pediatric and adult readmissions, as well as from the results of the qualitative interviews. We will use the results and assess whether there is an association between the presence of an intervention and risk adjusted readmission rates from Aim 1. These three aims will provide important insights into hospital variations in pediatric asthma readmission rates as well as possible interventions to help prevent them. A multi-disciplinary mentoring committee whose expertise spans the relevant disciplines of quality assessment and improvement (Drs. Dudley and Auerbach), asthma and health services research (Dr. Cabana), and qualitative and quantitative research (Drs. Halpern-Felsher and Dudley) will guide the progress of the research agenda. Their mentorship, as well as a focused training and research plan facilitated by a K23 award, will develop my expertise in pediatric quality of care research with a focus on pediatric readmissions. This educational and research agenda will enable me to achieve my goal of developing a nationally-respected research program to improve the quality of pediatric inpatient care, while furthering the NICHD's mission of ensuring that all children have the chance to achieve their full potential to lead healthy and productive lives.
Findings from the proposed plan will be relevant to the academic and policy arenas and ultimately further the field of pediatric quality to improve patient outcomes. Pediatric readmissions are an undesirable outcome in and of themselves, and may be a useful indicator of modifiable processes or structural factors to improve quality of care. In addition, asthma has a greater prevalence in minority populations, who often have poorer outcomes compared to non-minority peers, and the focus on asthma in the proposed plan will increase our likelihood of improving outcomes for these more vulnerable and at-risk populations. Many questions remain regarding what leads to pediatric asthma readmissions and therefore how to intervene to prevent them. The proposed plan will help answer some of these questions.
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