Potentially Preventable Readmissions RARE Mental Health Collab .

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Potentially Preventable ReadmissionsRARE Mental Health Collab.

Mark Sonneborn

February 2014

What are PPRs?• 3M software• Based on MHA administrative data• Measures readmissions to the same facility only

o ~ 22% go to different facilities, per literature

How to interpret the reports

© 3M 2007. All rights reserved.

General Guidelines for PPRs

Readmission

Initial Admission Medical Surgical

Medical PPR except if clearly unrelated acute events

Not PPR unless initial medical diagnosis clearly should have resulted in

surgery

SurgicalPPR except conditions

clearly unrelatedPPR if related to prior

surgery


PPR Global Exclusions If any of the following conditions apply to the initial admission, a

subsequent readmission is globally excluded from consideration as a PPR• Admissions for which follow-up care is intrinsically extensive and

complexo Major or metastatic malignancies treated medicallyo Multiple trauma, burns

• Discharge status indicates limited hospital & provider controlo Left against medical adviceo Transferred to another acute care hospital

• Neonates• Other exclusions

o Specific eye procedures and infectionso Cystic fibrosis with pulmonary diagnoses

• Died – not included as candidate initial admissions (denominator)


Clinical Factors make a readmission not potentially preventable

No clinical relationship to prior discharge• Cholecystectomy two weeks after hip replacement

Discharge status of prior discharge• AMA and transferred to another acute care hospital

Type of prior discharge• Follow-up care is intrinsically complex and extensive

o Metatastic malignancies, Multiple trauma, Burns Longer interval between discharge and

readmission• Long time intervals (>30 days) reduce confidence that

readmission is causally linked to the prior discharge


Non- PPR Reasons

How to interpret PPR results – Hospital-level

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs

Difference from Target A/E Ratio

172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90

PPRs is the actual number of PPRs detected during the time period


“At Risk Cases” is the denominator – it’s all cases minus the exclusions mentioned before

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


Actual Rate is PPRs divided by At Risk Cases

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


Expected Rate – this is a unique number for every hospital based on their patient population. Generally, hospitals with more severely ill patients will have higher expected rates.

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


One star is statistically “worse than expected” (or higher); Two stars is “no different than expected”; Three stars is “better than expected” (or lower)

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


Expected PPRs is the Expected Rate times the At Risk Cases

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


Target PPRs is 20% less than Expected PPRs

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90


Difference from Target is your actual PPRs (first column) minus the Target PPRs.

The goal for this hospital is to reduce by 18 PPRs per year.

PPRsAt Risk Cases

Actual Rate

Expected Rate

Expected PPRs

Target PPRs


172 3,820 4.5 5.0 ** 192.3 153.9 18.1 0.90

Actual to Expected Ratio

Actual Rate

Expected Rate A/E Ratio

4.5 5.0 0.90

An A/E Ratio above 1.0 is more than expected; below is less than expected.

The goal for the RARE campaign is to get the A/E ratio down to 0.80

Example Detail (Record-level) Report

ACCTNBR

MEDRECNO

ADMIT_YR

ADMIT_MM

ADMIT_DD

DISCHARGE_YR

DISCHARGE_MM

DISCHARGE_DD

APR_DRG APR_SOI

PPR_DAYS

RECORD_TYPE PDX

DISCHARGE_STATUS MDC

NORM_RATE DRG

2013 05 11 2013 05 13 140 1 #NULL! OA 49121 1 4 0.094996 1922013 07 03 2013 07 10 207 1 303 OA 4589 3 5 0.051087 3152013 05 06 2013 05 07 513 1 #NULL! IA 6262 1 13 0.020316 7432013 05 23 2013 05 25 813 2 16 RA 99831 1 21 0.070496 9202013 08 10 2013 08 13 560 2 #NULL! OA 65811 1 14 0 7742013 03 23 2013 04 02 460 3 15 RA 5849 3 11 0.114181 6832013 09 16 2013 09 17 246 2 #NULL! OA 5579 1 6 0.044374 3952013 07 01 2013 07 03 302 2 #NULL! OA 71536 1 8 0.028048 4702013 09 11 2013 09 12 223 1 #NULL! OA 5409 1 6 0.092424 3432013 05 03 2013 05 05 249 1 #NULL! OA 27651 1 6 0.032941 6412013 07 16 2013 07 18 560 1 #NULL! OA 64511 1 14 0 7752013 04 16 2013 04 17 560 2 #NULL! OA 66341 1 14 0 775

Detail Reports

• Acct #, Med Rec #• Admit, Discharge Date• APR-DRG, APR-DRG Severity of Illness

This is what the statewide norms are based on

• PPR days Days between discharge and admission

• Record Type 2-letter codes – THIS IS THE KEY FIELD

• Principal Diagnosis, MDC, DRG• Discharge Status• Statewide Norm

Hints for Using Detail Reports to Analyze Performance

Find patients that had potentially preventable readmissions• IA (Initial Admissions) have at least one affiliated RA

(Readmission)o All of the other two-letter codes are not for patients that were

readmitted

Use A/E ratio results from hospital-level report to hone in on certain types of cases

Look for patterns and characteristics of readmitted patients vs. non-readmitted• Are there differences in demographics or diagnoses?

Questions?

Mark Sonneborn, [email protected]

mailto:[email protected]

Potentially Preventable Readmissions RARE Mental Health Collab .

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