{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T00:30:26Z","timestamp":1793493026060,"version":"4.5.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVES<\/jats:title>\n                    <jats:p>Literature from Medicare beneficiaries suggests that hospital readmission metrics limited to inpatient encounters, omitting observation-status data, may not fully capture hospital performance and affect rankings. The impact of omitting observation-status data on this metric at the pediatric population level has not been fully assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>STUDY DESIGN<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed hospital stays for pediatric patients younger than 18\u00a0years old, using Healthcare Cost and Utilization Project state-specific databases from 5 states (Georgia, Iowa, Maryland, Nebraska, and Wisconsin) spanning 2016\u20132019. The primary outcome was the percentile change in hospital ranks based on 30-day risk-adjusted hospital readmission rates with and without observation-status data. We assessed correlations of the percentile change in hospital ranks with hospital-level percentage of observation-status use and with hospital pediatric care capability, reflecting diversity and complexity of pediatric care offered by a hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>There were a total of 288\u2009149 and 205\u2009107 eligible initial inpatient and observation stays, respectively. The 30-day unadjusted readmission rate was significantly different between the 2 groups of initial stays: 5.10% and 7.55% after initial observation and inpatient stays, respectively (P value &amp;lt;0.001). Hospitals with higher observation-status use tended to shift toward worse ranking positions after including observation-status data, whereas hospitals with lower observation-status use tended to shift toward better ranking positions. This pattern was particularly evident among tertiary children\u2019s hospitals, which had a median improvement of 11.9 percentile points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Hospitals with lower observation-status use were ranked lower for pediatric care when using the inpatient-only metric, with a disproportionately negative impact on tertiary children\u2019s hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/hpeds.2026-009375","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:02:12Z","timestamp":1788393732000},"page":"920-927","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Omitting Observation-Status Data on Hospital Readmission Metric for Pediatric Care"],"prefix":"10.1542","volume":"16","author":[{"given":"Yao","family":"Tian","sequence":"first","affiliation":[{"name":"1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"2Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"},{"name":"3Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children\u2019s Research Institute; Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle L.","family":"Macy","sequence":"additional","affiliation":[{"name":"3Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children\u2019s Research Institute; Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"},{"name":"4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay G.","family":"Berry","sequence":"additional","affiliation":[{"name":"5Department of Pediatrics, Harvard Medical School, Harvard University; Complex Care, Division of General Pediatrics, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"6Children\u2019s Hospital Association, Lenexa, Kansas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Hockenberry","sequence":"additional","affiliation":[{"name":"7Department of Health Policy & Management, Yale University School of Public Health, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald T.","family":"Ackermann","sequence":"additional","affiliation":[{"name":"8Department of Medicine,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber K.","family":"Sabbatini","sequence":"additional","affiliation":[{"name":"9Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Kan","sequence":"additional","affiliation":[{"name":"3Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children\u2019s Research Institute; Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois"},{"name":"4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Huang","sequence":"additional","affiliation":[{"name":"2Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane L.","family":"Holl","sequence":"additional","affiliation":[{"name":"10Department of Neurology, Biological Sciences Division and Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehul V.","family":"Raval","sequence":"additional","affiliation":[{"name":"1Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"2Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois"},{"name":"4Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois"},{"name":"11Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. 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