Study: PQI Tool Is Unable to Identify Preventable Hospital Admissions

Authors recommend further evaluation before tool is used in pay-for-performance programs

A study that compared preventable hospital admissions independently identified by physicians and the Prevention Quality Indicator (PQI) showed a level of agreement “no different than what would be expected by chance,” according to a report on the FierceHealthcare website. The PQI is a set of standardized measures developed by the Agency for Healthcare Research and Quality (AHRQ) and adopted by some pay-for-performance programs to target and reduce preventable admissions.

The study was conducted by researchers at the Cleveland Clinic Foundation in Ohio and at the University of Rochester in New York.

Rates of preventable admissions will soon be publicly reported and used in calculating performance-based payments, the study’s authors noted. The PQI, the current method of assessing preventable admissions, is drawn from claims data and was originally designed to assess population-level access to care.

The authors conducted a cross-sectional survey at an academic medical center to identify the prevalence and causes of preventable admissions by attending physician review and to compare its performance with the PQI tool in identifying preventable admissions. The study looked at consecutive inpatient admissions from December 1 to December 15, 2013.

The authors surveyed inpatient attending physicians regarding the preventability of the admissions, primary contributing factors, and the feasibility of prevention. For the same patients, the PQI tool was applied to determine the claims-derived preventable admission rate.

Physicians rated 322 admissions and classified 122 (38%) as preventable, of which 31 (25%) were readmissions. Readmissions were more likely to be rated preventable than other admissions (49% vs. 35%; P = 0.04). Application of the AHRQ PQI methodology identified 75 preventable admissions (23%). Thirty-one admissions (10%) were classified as preventable by both methods. Most of the admissions (44/78 [56%]) considered preventable by the AHRQ PQI were not considered preventable by physician assessment (P = 0.04). Of the preventable admissions, physicians assigned patient factors to 54 (44%), clinician factors to 36 (30%) and system factors to 32 (26%).

The PQI offers standardized data, but it “cannot identify an appropriate rate for hospital admissions within a given population,” the authors wrote; “therefore it cannot serve as a tool to help hospitals focus their prevention efforts.”

The authors recommended further study of the PQI before it is used in pay-for-performance programs.

Sources: FierceHealthcare; March 2, 2016; and Journal of General Internal Medicine; February 18, 2016.