Every preventable hospital admission represents both a significant cost to the health care system and evidence of an ambulatory care system failure. The challenge has been to define “preventable” with an understanding that the preventability of these admissions depends on the overall burden of illness of the individual patient. In 2012, Solventum met this challenge by releasing the Solventum™ Potentially Preventable Admissions (PPAs) Classification System as one of the three Population-focused Preventables. Learn more. (The others are Potentially Preventable Emergency Department Visits and Potentially Preventable Services.)
As with all Solventum PPE methodologies, three core concepts are essential. First, we recognize that not all admissions are potentially preventable. Second, what matters is not the individual admission, but rather the overall rate of potentially preventable admissions. Instead of approaching quality with the mindset of “This should never happen,” we use a more realistic and meaningful approach of “This has happened too often.” Third, any comparisons across populations of patients must be risk-adjusted. In practice, that means that the actual Solventum PPA experience of a population is compared with the experience that would be expected for a population with the same case mix.
The Solventum PPA logic is divided into two phases:
1. Identify patients with potentially preventable initial admissions
All inpatient stays are assigned to a Solventum™ All Patient Refined Diagnosis Related Groups (APR DRGs) Classification System. For the general population, approximately 41 base Solventum APR DRGs are considered potentially preventable. For some Solventum APR DRGs, the Solventum PPA logic also takes into account individual diagnoses and patient age. In a Minnesota all-payer analysisopens in a new tab, for example, the most common Solventum PPAs were pneumonia, heart failure and COPD. When an integrated health delivery system (such as a managed care organization or accountable care organization) accepts responsibility for a specific population, then additional Solventum APR DRGs are considered potentially preventable, for a total of approximately 100. Examples of additional Solventum APR DRGs include bipolar disorder, sickle cell anemia crisis and inflammatory bowel disease. When a population is under the care of a residential nursing care facility (such as a nursing facility, intermediate care facility or residential treatment center), additional Solventum APR DRGs are considered potentially preventable, for a total of approximately 126. For example, Solventum analysisopens in a new tab showed that Solventum APR DRG 720, Septicemia and Disseminated Infections, was the most common Solventum PPA in a population of more than 400,000 Medicare nursing facility patients.
2. Determine patient risk adjustment
In any rate-based comparison of outcomes, risk adjustment is essential to a fair comparison across populations. Although Solventum PPAs are generally preventable, they will never be totally eliminated, even with optimal care. As a result, there will be a residual rate of Solventum PPAs in even the best-performing systems. More importantly, the rate at which Solventum PPAs occur depends on the burden of illness of the population which is measured using Solventum™ Clinical Risk Groups (CRGs) Classification System. For example, Solventum CRG 70602 is a person with congestive heart failure, diabetes and chronic obstructive pulmonary disease, severity 2. Hospital admissions for this person would be more likely to be preventable than for a person in severity 5 (i.e., Solventum CRG 70605).
Further information on the Solventum PPA logic is available in the Population-focused Preventables Methodology Overview. Detailed information is available to licensees in the online PFP definitions manual.
The Solventum PPA clinical logic is maintained by a team of Solventum clinicians, data analysts, nosologists, programmers and economists. The methodology is updated annually to reflect changes in the standard diagnosis and procedure code sets as well as Solventum enhancements to the clinical logic.