Agree to disagree? Physicians and Prevention Quality Indicator at odds on preventable admissions — 7 insights

Physicians often disagree with what the standardized Prevention Quality Indicator deems as preventable admissions, as found in a recent study, according to Medscape.

In the study, researchers compared a hospital's rate of preventable admissions using the PQI with the rate the physician determined. To determine the rate, an attending physician would assess a patient on the second day of an admission to evaluate whether any clinician, system or patient factor in the two weeks prior to admission could have been addressed to avoid the admission.

Physicians also selected from a list of factors based on past research findings. From that list, the physician also determined whether the primary contributing factor would be very easy, somewhat easy, somewhat difficult or very difficult to address.

Journal of General Internal Medicine published the study online.

Here are seven insights:

1. The study found physicians and the PQI agreed on the preventability of merely 9.6 percent of overall admissions.

2. From Dec. 3 to Dec. 15, 2015, physicians classified 38 percent of the admissions as preventable. Of these admissions, 25 percent were readmissions.

3. Physicians rated 49 percent of readmissions as preventable compared with 35 percent of the other admissions.

4. Physicians classified 44 percent of admissions as preventable based on patient factors such as non-adherence (17 percent), mental health/ substance abuse (8 percent) and the remaining from poor health literary, secondary gain from hospitalization and poor home support.

5. Physicians deemed 26 percent of admissions were due to system factors such as inpatient management surpassing that of outpatient management, insufficient nursing facility care, limited access to outpatient providers and a complication from a previous admission.

6. Physicians found 30 percent of preventable admissions were due to clinician factors such as too low a threshold for admission (9 percent), inadequate follow-up (8 percent) and inappropriate diagnosis or treatment (7 percent).

7. The PQI identified 23 percent of overall admissions were preventable. Of this figure, physicians classified only 44 percent as preventable.  

"For healthcare providers to reduce admission rates, they must understand why preventable admissions occur: 52 percent of the preventable admissions in our study were considered very or somewhat easy to prevent," the authors wrote. "These were more likely to be due to clinician factors such as inadequate follow-up, no contact between the admitting MD and primary care provider and the low threshold for admission"

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