1 / 21

apr-drgs hospital centricreadmission module

9/26/2011. This Session Will Provide : . A summary of research findings on hospital readmissionsSummary of the APR-DRG Readmission ModuleSuggestions for future collaboration. 9/26/2011. 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 careful23

paul
Télécharger la présentation

apr-drgs hospital centricreadmission module

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. APR-DRGs (Hospital Centric)Readmission Module 3M HIS Clinical Research Department

    2. 9/26/2011

    3. 9/26/2011 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. 9/26/2011 Current APR-DRG Research: (Hospital Centric) Readmission Module Hypothesis: Readmissions – e.g. within 15 or 30 days are useful for two purposes – identify opportunities for quality improvement in the index hospitalization and/or identify good candidates for care management after hospital discharge

    5. 9/26/2011 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. 9/26/2011

    7. 9/26/2011

    8. 9/26/2011 Research Approach for the Development of the APR-DRG Readmission Module Provide Readmission Definition Develop logic. Specify classification system identifying which APR subclasses we hypothesize as likely resulting in a readmission Test the classification methodology with appropriate data bases

    9. 9/26/2011 With this as background, the following general definition of readmission is provided A readmission to the hospital within 15 days is considered applicable for the APR-DRG readmission methodology if reasonable clinicians would agree that the readmission was likely related to the index hospital stay. The APR-DRG readmission methodology contains detailed logic excluding readmissions unlikely to be related to the index hospitalization and excluding readmissions unlikely to represent a quality improvement opportunity for either the hospital stay and/or the coordination process between the hospital discharge team and the receiving outpatient health care team.

    10. 9/26/2011 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.

    11. 9/26/2011 Level of care of return Probably the most fundamental element of a hospital readmission is the level of care to which the return occurs. By definition, the APR-DRG readmission module involves the return of a patient to inpatient acute care. It is beyond the scope of this effort to examine admissions after hospital discharge to other intermediate levels of care such as nursing homes or rehabilitation hospitals.

    12. 9/26/2011 Time period of return  Experience suggests that a flexible approach to defining time periods for hospital readmissions may be best. This type of definition can initially focus on 15 days, then extend to longer intervals such as 30 days as more experience with the use of this indicator is developed and hospitals increasingly coordinate services with the outpatient sector.

    13. 9/26/2011 Clinical definition of return While some pay for performance arrangements identify an index condition/procedure (e.g. CABG) and consider all hospital admissions occurring within 15 or 30 days as readmissions, it is important to have a clearly specified methodology that excludes admissions that are likely not to be related to the index admission.

    14. 9/26/2011 The following types of readmissions are excluded from the APR-DRG readmission methodology -readmissions for which there is no possible clinical relation to the index admission (hip replacement two weeks after a finger operation); -readmissions that are not clearly related to improvement opportunities in either hospital or outpatient care (e.g. readmissions for malignancy care or motor vehicle accidents); and

    15. 9/26/2011

    16. 9/26/2011 Thus, for example: Any elective surgical admission that occurs after a medical admission is not considered to be related and thus “terminates” a chain.

    17. 9/26/2011 Sample Cases with DRGS Selected for Defining Readmission Rates

    18. 9/26/2011

    19. 9/26/2011 Coronary Bypass with Cardiac Cath

    20. 9/26/2011 COPD – 30 Day Readmissions

    21. 9/26/2011 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 Year 2 Recommendation: Consider working with employers/managed care organizations to help specify year long readmission rates – a complementary measure to hospital centric readmission module.

More Related