Lower quality of care was not associated with pneumonia readmissions, according to a study using a commercially available software program to examine possibly preventable readmissions.
Rates of hospital readmission are now being used to demonstrate hospital performance and the Centers for Medicare & Medicaid Services may even penalize hospitals with high rates of readmissions. As a result, it has become increasingly important to recognize clinical situations that may lead to a potentially preventable readmission.
The Potentially Preventable Readmission (PPRs) software was developed by 3M Health Information Systems to identify such cases and is being adopted by some state Medicaid programs for hospital payment and reporting. Dr. Ann M. Borzecki of the Center for Healthcare Organization and Implementation Research in Bedford, Mass., and her colleagues sought to understand if patients with pneumonia flagged by the PPR software as preventable readmissions were associated with failures in the process of care.
The investigators conducted a cross-sectional retrospective observational study with Veterans Affairs electronic medical record (EMR) data from October 2005 to September 2010. Patients with diagnoses of pneumonia and a 30-day readmission were identified and then flagged as PPR-yes (for example, readmissions associated with quality of care problems) vs. PPR-no, using the 3M PPR software. A tool to measure quality of care was applied to 100 random readmissions abstracted for full review. The study was published online Sept. 14 in BMJ Quality and Safety. (http://qualitysafety.bmj.com/lookup/doi/10.1136/bmjqs-2015-003911).
Of all the pneumonia readmission cases, 72% were PPR-yes vs.77% of the 100 abstracted cases. There were no significant differences between the groups other than a trend toward more comorbidity in the PPR-yes group.
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After researchers adjusted for comorbidities and demographics, they noted no significant difference in quality of care between the PPR-yes and PPR-no groups. Interestingly, the PPR-yes group had slightly higher quality scores than did the PPR-no group (total scores, 71.2 vs. 65.8 respectively, P = .14).
The authors write, “Among veterans readmitted after a pneumonia discharge, we found no significant difference in quality of care, as measured by processes of care received during the index admission and after discharge, between cases flagged as PPRs and nonflagged cases. Indeed, contrary to our hypothesis, quality scores were slightly higher among PPR-flagged cases.”
The authors emphasized that causes of readmissions are multifaceted and many aspects may be out of the control of the hospital. However, they noted a concern for a lack of postdischarge documentation and emphasized the need for thorough documentation at all levels of care.
The authors report no competing interest. The study was funded by the U.S. Department of Veterans Affairs Health Service Research and Development Service.