Background/Purpose: Early hospital readmission is
emerging as an indicator of care quality. The reported 30-day hospital
readmission (30-DHR) rate for pediatric patients is 6.5%. However, Childhood
SLE (cSLE) has a wide spectrum of health care complexity and disease course. There
is limited data describing cSLE rehospitalizations patterns and its impact on the
health care system. In this study we sought to describe patient- and hospital-level
characteristics for cSLE 30-DHR.

Methods: The Pediatric Health Information System (PHIS)
database was used to query cSLE for 5 years (2009-2013). Data collection
included patient characteristics, hospital characteristics (also collected from
American Hospital Association), length of stay (LOS), day of discharge, payer
type and hospital charges. Primary outcome measures analyzed was 30-DHR after prior
discharge. Multilevel models were used to accommodate dependence between
observations. Patient characteristics (such as gender & race) were nested
in patients and hospital characteristics (such as total beds & total
30-DHR) were nested in hospitals. Independent observations were analyzed within
the encounter.

Results: There were 1,755 unique cSLE patients and 3,751
admissions with total hospital charges of $191M USD. Among that sample, there
were more female (81%) than male (19%) patients. The overall cSLE 30-DHR rate
was 28 per 100 admissions (ranged from 0-58); 79 (5%), 35 (2%), and 95 (5%) patients
experienced 2, 3, and ≥4 30-DHR respectively. Thirty-day all-cause
hospital readmissions for cSLE patients in PHIS hospitals cost the health care
system $7M USD annually. There was a 3-fold variation in hospital service costs
(between upper and lower quartile) with median admission’s adjusted hospital
charges of $13,904**. Patients with 30-DHR had lower median LOS (2 vs 4 days)
and were more likely discharge on weekend (Sat & Sun)**. Weekend discharges
also seemed to have lower LOS of 2 days**. Patients with more diagnosis count
and chronic conditions during index admission were less likely to be readmitted**.
Total 30-DHR per hospital was associated with total admissions but not hospital
size (represented as total beds) or service area (represented as outpatient
visits). There was institutional and regional variation in 30-DHR**. Age and race/ethnicity
were not statistically significant for 30-DHR. **(P < 0.01).

Conclusion: 30-DHR is high among admitted cSLE patients.
Most hospitalizations in cSLE are for the treatment of disease manifestations,
infections or associated medical co-morbidities. There is a variation between
hospitals that may be due to patient population or practice differences. Our
study highlights the need for additional research to understand these
differences and to identify the most cost-effective strategies for managing cSLE
across the continuum of care.