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Do pneumonia readmissions flagged as potentially preventable by the 3M PPR software have more process of care
Ann M Borzecki1, Qi Chen2, Joseph Restuccia3
1Center for Healthcare Organization and Implementation Research, Bedford VAMC Campus, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
Background:
In the USA, administrative data-based readmission rates such as the Centers for Medicare and Medicaid Services' all-cause readmission measures are used for public reporting and hospital payment penalties. To improve this measure and identify better quality improvement targets, 3M developed the Potentially Preventable Readmissions (PPRs) measure. It matches clinically related index admission and readmission diagnoses that may indicate readmissions resulting from admission- or post-discharge-related quality problems.
Objective:
To examine whether PPR software-flagged pneumonia readmissions are associated with poorer quality of care.
Methods:
Using a retrospective observational study design and Veterans Health Administration (VA) data, we identified pneumonia discharges associated with 30-day readmissions, and then flagged cases as PPR-yes or PPR-no using the PPR software. To assess quality of care, we abstracted electronic medical records of 100 random readmissions using a tool containing explicit care processes organised into admission work-up, in-hospital evaluation/treatment, discharge readiness and post-discharge period. We derived quality scores, scaled to a maximum of 25 per section (maximum total score=100) and compared cases by total and section-specific mean scores using t tests and effect size (ES) to characterise the clinical significance of findings.
Results:
Our abstraction sample was selected from 11,278 pneumonia readmissions (readmission rate=16.5%) during 1 October 2005-30 September 2010; 77% were flagged as PPR-yes. Contrary to expectations, total and section mean quality scores were slightly higher, although non-significantly, among PPR-yes (N=77) versus PPR-no (N=23) cases (respective total scores, 71.2±8.7 vs 65.8±11.5, p=0.14); differences demonstrated ES >0.30 overall and for admission work-up and post-discharge period sections.
Conclusions:
Among VA pneumonia readmissions, PPR categorisation did not produce the expected quality of care findings. Either PPR-yes cases are not more preventable, or preventability assessment requires other data collection methods to capture poorly documented processes (eg, direct observation).
Insights
Potentially Preventable Readmissions (PPRs) did not correlate with lower quality of care in VA pneumonia readmissions. Further research using different data collection methods is needed to assess preventability accurately.
Area of Science:
- Healthcare Quality Improvement
- Health Services Research
- Clinical Informatics
Background:
- Readmission rates are key performance indicators for hospitals, influencing public reporting and payment.
- The 3M Potentially Preventable Readmissions (PPRs) measure was developed to identify readmissions linked to quality of care issues.
- PPRs analyze clinically related diagnoses between index admissions and readmissions.
Purpose of the Study:
- To investigate the association between PPR software-flagged pneumonia readmissions and the quality of care provided.
- To determine if PPR categorization accurately reflects care quality in pneumonia readmissions within the Veterans Health Administration (VA).
Main Methods:
- A retrospective observational study using VA data analyzed pneumonia discharges with 30-day readmissions.
- Pneumonia readmissions were categorized as PPR-yes or PPR-no using PPR software.
- Electronic medical records of 100 random readmissions were abstracted to assess care quality across four domains, generating scores up to 100.
Main Results:
- The study analyzed 11,278 pneumonia readmissions, with 77% flagged as PPR-yes.
- Contrary to expectations, mean quality scores were non-significantly higher in the PPR-yes group (71.2) compared to the PPR-no group (65.8).
- Effect sizes indicated small to moderate differences, particularly in admission work-up and post-discharge care.
Conclusions:
- PPR categorization did not reveal expected differences in quality of care for VA pneumonia readmissions.
- The findings suggest that PPR-yes cases may not be more preventable, or that current data collection methods are insufficient.
- Alternative data collection strategies, such as direct observation, may be necessary to accurately assess the preventability of readmissions.
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