Abstract
BackgroundIdentification of potentially preventable readmissions is typically accomplished through manual review or automated classification. Little is known about the concordance of these methods.MethodsWe manually reviewed 459 30-day, all-cause readmissions at 18 Kaiser Permanente Northern California hospitals, determining potential preventability through a four-step manual review process that included a chart review tool, interviews with patients, their families, and treating providers, and nurse reviewer and physician evaluation of findings and determination of preventability on a five-point scale. We reassessed the same readmissions with 3 M’s Potentially Preventable Readmission (PPR) software. We examined between-method agreement and the specificity and sensitivity of the PPR software using manual review as the reference.ResultsAutomated classification and manual review respectively identified 78% (358) and 47% (227) of readmissions as potentially preventable. Overall, the methods agreed about the preventability of 56% (258) of readmissions. Using manual review as the reference, the sensitivity of PPR was 85% and specificity was 28%.ConclusionsConcordance between methods was not high enough to replace manual review with automated classification as the primary method of identifying preventable 30-day, all-cause readmission for quality improvement purposes.
Highlights
Identification of potentially preventable readmissions is typically accomplished through manual review or automated classification
Design We compared a manual review of readmissions to automated classification by the Potentially Preventable Readmission (PPR) software from 3 M
Specificity refers to the percentage of non-potentially preventable readmissions identified by manual review that were identified as such by the software program
Summary
Identification of potentially preventable readmissions is typically accomplished through manual review or automated classification. Little is known about the concordance of these methods. Hospital readmissions are expensive and may reflect poor quality care. Under the new Readmissions Reduction Program, the U.S Centers for Medicare and Medicaid Services reduces payments to hospitals with excess 30-day readmission rates [1]. Many hospitals are interested in identifying preventable readmissions and understanding how they can be prevented. Classifying readmissions as potentially preventable or not preventable can be used to improve hospital performance. Administrators can sort potentially preventable readmissions into categories that are actionable for improvement. They can identify trends over time or across reporting units.
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