APRDRGs Readmission Module

1
APR-DRGs Readmission Module

• 3M HIS
• Clinical Research Department

2
This Session Will Provide

• Summary of the APR-DRG Readmission Module
• Our preliminary suggestions for Reporting Formats
  for Public Disclosure
• Suggestions for future collaboration we welcome
  your input

3
IMPORTANT CAVEATS

• Not all readmissions are preventable! In theory
  all Ambulatory Care Sensitive Conditions are
  preventable(but of course not really)
• It is the rates that we are interested in!
• Even if we are primarily interested in the rates,
  readmission rate must have clinical meaning and
  thus must be carefully defined.

4
Current APR-DRG Research (Hospital, not
Patient,Centric) Readmission Module

• Hypothesis Readmissions e.g. within 15 days
  are useful for two purposes identify
  opportunities for quality improvement in the
  initial/index hospitalization and/or identify
  good candidates for care management after
  hospital discharge

5
It is fairly clear from the extensive literature
that the hospital can assist in avoiding
readmissions by a combination of

• providing excellent care during the first
  hospitalization and 
• putting into place the best possible coordination
  plans with the outpatient setting including
  both the outpatient health professional team and
  the patient/family/caregiver.

6
Develop Logic. Define Parameters

•     the site (e.g. nursing home, rehabilitation,
  hospital) of care to which the return occurs
• time period within which the return occurs
•  
•         the clinical definition of the return
  and
•  
•         the type of admission of the return.

7
Issues for Discussion in Public Reporting

• Start with one number and then allow the user to
  dig deeper how deep?
• Types of hospitals like with like or across the
  board?
• Minimum numbers needed for comparison
• Age range breakout reports
• Visual display

8
Hospital vs Human Centric Readmission Rates

• Need to emphasize that the work that is being
  implemented is hospital centric i.e.
  readmission rates after a hospital admission
  adjusted by discharge severity
• Over time should consider also including
  separately a human centric point of view
  admission rates by person adjusted for their
  chronic illnesses
• Human centric hospital admission rates are
  particularly relevant for disease management,
  care management, and/or managed care

9
Fifteen vs Thirty Day Readmission Rates

• Our recommendation start with 15 and then
  increase the window over time.

10
Types of Reports

• Overall readmission
• Medical vs surgical vs mental health/substance
  abuse
• Major Surgery one report
• No Major Medical
• Service line reports split by medical/surgical
• DRG specific analyses (when volume permits) CABG,
  MI, Asthma,

11
Communication issues

• Disease specific e.g. major surgery
• Low income issues barriers to access for
  information

12
Readmission Rate- Major Surgical Procedures 15
days
13
Service lines examples one summary number

• Cardiovascular surgery
• Medical Neurological Care
• etc

14
Coronary Bypass with Cardiac Cath-30 days
15
Summary of Module

• The APR-DRG Readmission Module is a clinically
  meaningful classification system which provides
  useful information to consumers and hospitals on
  hospital centric readmission rates.
• Year 1 Recommendation Consider Implementation
  of APR-DRG Readmission module
• Implementation issues including report format
• Year 2 Recommendation Consider working with
  employers/managed care organizations to help
  specify year or HUMAN long readmission rates a
  complementary measure to hospital centric
  readmission module.