Impact of initial length of stay (ILOS) on 30-day readmission risk in pediatric asthma patients: implications for accountable care

Abstract

The emphasis on reducing readmissions implies that an association exists between the utilization of hospital resources and readmission risk. This study was designed to explore this association. The sample cohort (n=4965) included all asthma discharges from January 2008 through August 2012 discharged from Children's Hospitals and Clinics of Minnesota (CHC MN). Multiple logistic regression was used to test associations. Adjusting for covariates, we found no significant association between initial length of stay (ILOS) and readmission (OR:1.04[95%CI:0.98-1.10]). Analyzing ILOS categorically by day, one-day stays did not have a significantly higher readmission risk (OR:1.27[95% CI: 0.87-1.85]) than two-day stays. Observed risk increased as ILOS exceeded 2 days but was not significantly different by day. We found no association when comparing the difference in actual vs expected ILOS and readmission risk. Altering ILOS is not likely to reduce readmissions in pediatric asthma patients. Prolonging ILOS dramatically increases costs with little reduction in readmissions.