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16. Assessing 30-day avoidable readmission rates: Is it an appropriate tool to manage emergency department quality of care?

Author

Eggli Yves, Agri Fabio, and Fabrice Dami

Subjects
Hospital readmission, business.industry, Medical record, Liability, False positive paradox, medicine, Quality level, Disease, Emergency department, Medical emergency, Quality of care, medicine.disease, business
Abstract

Objective: Quality indicators, based on administrative data, are being increasingly used to assess avoidable hospital readmission rates. Their potential to identify areas for improvement at low cost is attractive, but their performance in emergency departments (EDs) has been criticised.Methods: Hospital readmissions were categorised as potentially avoidable or non-avoidable, by a computerised algorithm (SQLape®, version 2016 - Striving for Quality Level and analysing of patient expenditures). Half-yearly rates were reported between July 2015 and June 2016. Two senior physicians conducted a medical record review on 100 randomly selected cases from an ED, flagged as potentially avoidable readmissions (PAR). Results were then discussed with the algorithm’s designer.Results: The algorithm screened 2,182 eligible emergency visits - 105 cases (4.8%), were deemed potentially avoidable by the algorithm. Among 100 randomly selected cases, nine exclusions were due to coding issues and four due to false positives. Overall (N = 87), 20/87 (23%) of readmissions were directly related to sole emergency care, 31/87 (36%) related to healthcare providers other than the ED, and 23/87 (26%) were of mixed provision, while 13/87 (15%) were attributed to the course of the disease.Conclusions: The study confirms the need for a better understanding of the algorithm’s measurement and of its reported results. Careful interpretation is required before a sound conclusion can be made. Indeed, it is apparent that the 30-day PAR quality indicator rate reflects a wider parameter of care than hospitals alone, who understandably tend to concentrate on their own, direct liability of care. In particular the 30-day PAR quality indicator is not well-suited to evaluate ED performance.

Published
2020

20. Cost Analysis of Outpatient Colectomy in a Tertiary Center: A Projected Medico-Economic Evaluation.

Author

Agri F, Möller W, Deslarzes P, Vogel CA, Hahnloser D, Hubner M, Demartines N, and Grass F

Abstract

Aim of the Study: Short stay processes are incentives to unburden chronically stressed healthcare systems. The aim of this study is to analyze financial implications of day admission (DAS) and outpatient strategies for colon resections in a prospective payment system (PPS) using Diagnosis Related Group (DRG) coding., Methods: Consecutive patients undergoing left and right colonic resections between January 1, 2019 and December 31, 2020 were included. Medico-economic evaluations of the virtual outpatient and day admission surgery groups based on predefined criteria were compared to the identical group of patients who underwent surgery in the actual traditional inpatient setting. In a second step, postoperative complications of the virtual outpatient group were assessed. Cost-revenue analysis was performed using a micro-costing approach including direct medical costs., Results: Overall (N = 257), 97 (37.7%) colectomies would have been potentially eligible for an outpatient strategy. The global costs of the actual inpatient strategy totaled USD 3 634 392 with a global revenue of USD 3 571 069, corresponding to a cost coverage rate of 98%. The result of the virtual DAS strategy would have been a net loss of USD 15 800 (coverage rate of 99%) due to 4 low length of stay outliers triggering a reimbursement reduction and preventing a positive net result of USD 16 208. The pilot reference outpatient case's revenue and cost amounted to respectively USD 7479 and USD 6911 (cost coverage of 108%)., Conclusion: From both any given hospital and healthcare system point of view, elective outpatient colectomy for selected patients is the most cost-saving option. However, in a prospective payment system implemented to avoid bad incentives, the latter can unintentionally disadvantage best performing hospitals and impede widespread adoption of high-value strategies., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Published
2024
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