TY - JOUR
T1 - Factorial analysis quantifies the effects of pediatric discharge bundle on hospital readmission
AU - Behalf of the Impact Study Group
AU - Osorio, Snezana Nena
AU - Gage, Sandra
AU - Mallory, Leah
AU - Soung, Paula
AU - Satty, Alexandra
AU - Abramson, Erika L.
AU - Provost, Lloyd
AU - Cooperberg, David
AU - Hampton, Elisa
AU - Alleyne, Felicia
AU - Schmutter, Lisa
AU - DiPace, Jennifer
AU - Ono, Jennie
AU - Spector, Brooke
AU - Green, Cori
AU - Jirasevijinda, Thanakorn
AU - Popatia, Rizwana
AU - Preston, MacKenzi
AU - Lee, Jessie
AU - Whiffen, Amy
AU - Smith, Sarah
AU - Rico, E. M.
AU - Genow, Brianne
AU - Powers, Sara
AU - Costomiris, Susan
AU - Key, Drisdy
AU - Giannini, Jennifer
AU - Nataraj, Courtney
AU - Small, Jennifer
AU - LaRose, Kimberly
AU - Guerra, Mariela
AU - Manchester, Nicole
AU - Bellevue, Agatha
AU - Lord, Melanie
AU - Morgan, Teresa
AU - Bouthot, Nancy
AU - Martens, Anna
AU - DiCesare, Danielle
AU - Ronan, Clare
AU - Bhattacharya, Abihijit
AU - McElwain, Lorraine
AU - Jewell, Jennifer
AU - Hayman, Jennifer
AU - Bennett, Shannon
AU - Murray, Logan
AU - Diminick, Noah
AU - Bausman, Jonathan
AU - Kondrad, Monica
AU - Cray, Sharon
AU - Sanders, Benjamin
N1 - Publisher Copyright:
© 2021 American Academy of Pediatrics. All rights reserved.
PY - 2021/10/1
Y1 - 2021/10/1
N2 - BACKGROUND AND OBJECTIVES: Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4- element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS: A 24factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS: RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS: The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
AB - BACKGROUND AND OBJECTIVES: Factorial design of a natural experiment was used to quantify the benefit of individual and combined bundle elements from a 4- element discharge transition bundle (checklist, teach-back, handoff to outpatient providers, and postdischarge phone call) on 30-day readmission rates (RRs). METHODS: A 24factorial design matrix of 4 bundle element combinations was developed by using patient data (N = 7725) collected from January 2014 to December 2017 from 4 hospitals. Patients were classified into 3 clinical risk groups (CRGs): no chronic disease (CRG1), single chronic condition (CRG2), and complex chronic condition (CRG3). Estimated main effects of each bundle element and their interactions were evaluated by using Study-It software. Because of variation in subgroup size, important effects from the factorial analysis were determined by using weighted effect estimates. RESULTS: RR in CRG1 was 3.5% (n = 4003), 4.1% in CRG2 (n = 1936), and 17.6% in CRG3 (n = 1786). Across the 3 CRGs, the number of subjects in the factorial groupings ranged from 16 to 674. The single most effective element in reducing RR was the checklist in CRG1 and CRG2 (reducing RR by 1.3% and 3.0%) and teach-back in CRG3 (by 4.7%) The combination of teach-back plus a checklist had the greatest effect on reducing RR in CRG3 by 5.3%. CONCLUSIONS: The effect of bundle elements varied across risk groups, indicating that transition needs may vary on the basis of population. The combined use of teach-back plus a checklist had the greatest impact on reducing RR for medically complex patients.
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U2 - 10.1542/peds.2021-049926
DO - 10.1542/peds.2021-049926
M3 - Article
C2 - 34593650
AN - SCOPUS:85116535940
SN - 0031-4005
VL - 148
JO - Pediatrics
JF - Pediatrics
IS - 4
M1 - e2021049926
ER -