Faculty Collaboration Database

Factorial Analysis Quantifies the Effects of Pediatric Discharge Bundle on Hospital Readmission. Pediatrics 2021 Oct;148(4)

Date

10/02/2021

Pubmed ID

34593650

DOI

10.1542/peds.2021-049926

Scopus ID

2-s2.0-85116535940 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

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 2⁴ factorial 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.

Author List

Osorio SN, Gage S, Mallory L, Soung P, Satty A, Abramson EL, Provost L, Cooperberg D, IMPACT STUDY GROUP

Author

Paula Soung MD Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aftercare
Ambulatory Care
Checklist
Child
Child, Hospitalized
Child, Preschool
Factor Analysis, Statistical
Female
Humans
Male
Patient Care Bundles
Patient Discharge
Patient Education as Topic
Patient Readmission
Retrospective Studies
Teach-Back Communication