Rates and Impact of Potentially Preventable Readmissions at Children's Hospitals - 25/02/15
, Rishi Agrawal, MD, MPH 2, Katherine A. Auger, MD, MSc 3, Mark A. Del Beccaro, MD 4, Pirooz Eghtesady, MD, PhD 5, Evan S. Fieldston, MD, MBA, MS 6, Justin Golias, RHIA, CHDA 7, Paul D. Hain, MD 8, Richard McClead, MD 9, Rustin B. Morse, MD, MMM 10, Mark I. Neuman, MD, MPH 11, Harold K. Simon, MD, MBA 12, Javier Tejedor-Sojo, MD 12, Ronald J. Teufel, MD, MSCR 13, J. Mitchell Harris, PhD 14, Samir S. Shah, MD, MSCE 3Abstract |
Objective |
To assess readmission rates identified by 3M-Potentially Preventable Readmissions software (3M-PPRs) in a national cohort of children's hospitals.
Study design |
A total of 1 719 617 hospitalizations for 1 531 828 unique patients in 58 children's hospitals from 2009 to 2011 from the Children's Hospital Association Case-Mix Comparative database were examined. Main outcome measures included rates, diagnoses, and costs of potentially preventable readmissions (PPRs) and all-cause readmissions.
Results |
The 7-, 15-, and 30-day rates by 3M-PPRs were 2.5%, 4.1%, and 6.2%, respectively. Corresponding all-cause readmission rates were 5.0%, 8.7%, and 13.3%. At 30 days, 60.6% of all-cause readmissions were considered nonpreventable by 3M-PPRs, more than one-half of which were related to malignancies. The percentage of readmissions rated as potentially preventable was similar at all 3 time intervals. Readmissions after chemotherapy, acute leukemia, and cystic fibrosis were all considered nonpreventable, and at least 80% of readmissions after index admissions for sickle cell crisis, bronchiolitis, ventricular shunt procedures, asthma, and appendectomy were designated potentially preventable. Total costs for all readmissions were $1.7 billion; PPRs accounted for 27.3% of these costs. The most costly readmissions were associated with ventricular shunt procedures ($26.5 million/year), seizures ($15.5 million/year), and sickle cell crisis ($15.0 million/year).
Conclusions |
Rates of PPRs were significantly lower than all-cause readmission rates more than one-half of which were caused by exclusion of malignancies. Annual costs of PPRs, although significant in the aggregate, appear to represent a much smaller cost-savings opportunity for children than for adults. Our study may help guide children's hospitals to focus readmission reduction strategies on areas where the financial vulnerability is greatest based on 3M-PPRs.
Le texte complet de cet article est disponible en PDF.Keyword : 3M-PPRs, APR-DRGs, PPR
Plan
| K.A. received salary support from the Robert Wood Johnson Foundation Clinical Scholars Program at the University of Michigan. Children's Hospital Association (formerly the National Association of Children's Hospitals and Related Institutions) is a research partner with 3M Health Information Systems (3M-HIS), which participated in the development of 3M grouping software. CHA currently receives royalties from 3M for past participation in these efforts. 3M-HIS was given the opportunity to review the current manuscript before submission and provided comments to the authors, but had no input into study design, the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. This work and the views and opinions expressed herein are solely those of the authors and not of the Children's Hospital Association. The authors declare no conflicts of interest. |
Vol 166 - N° 3
P. 613 - mars 2015 Retour au numéro
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