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Identify potentially preventable admissions, a population-based quality of care outcome measure, using powerful clinical grouping logic
The 3M™ Potentially Preventable Admissions (PPA) methodology identifies hospital admissions that could have potentially been preventable with better coordinated care. The use of quality outcome measures can expand upon currently available process measures and can speed the transformation to an efficient and effective outcomes-based health care delivery system. 3M PPAs are more comprehensive in large part because of advances in our understanding of the role coordinated care can play in avoiding admissions together with the understanding that the preventability of these events should be adjusted for the overall burden of illness of the individual patient.
Every year, millions of patients are admitted to hospitals for chronic disease exacerbations that were potentially preventable with better management in the community. Reducing such potentially unnecessary admissions both saves money and improves patient outcomes.
The 3M™ Potentially Preventable Admissions (PPA) methodology is a clinical classification system that identifies avoidable initial hospital admissions. 3M PPA uses the industry-standard 3M™ All Patient Refined DRG (APR DRG) Classification System to identify the preventable admission and 3M™ Clinical Risk Grouping (CRG) Software to risk-adjust the comparison data.
Accurate and fair 3M PPA identification requires careful, clinically defined risk adjustment. The widely accepted 3M™ Clinical Risk Grouping (CRG) Software measures baseline population health status in comparing actual versus expected 3M PPA rates.
3M PPA is one of the five 3M™ Potentially Preventable Event methodologies that generate specific results for clinicians and health care managers to use in improving care and reducing cost.
Organizations that accept responsibility for the care of identified populations can be held to higher standards. 3M PPA methodology identifies approximately 41 potentially preventable reasons for admission in the general population, 100 reasons in populations managed by integrated health delivery systems, and 126 reasons in populations from residential nursing care facilities.
All about 3M PPA
The 3M PPA methodology generates actionable insights that can help lower costs and improve outcomes.
The 3M PPA methodology identifies hospital admissions that could potentially have been dealt with in the outpatient setting. These hospital admissions may result from hospital and/or ambulatory care inefficiency, lack of adequate access to outpatient care, or inadequate coordination of ambulatory care services.
In many cases, 3M PPA can uncover flare-ups of chronic conditions (e.g., asthma), which could have been avoided through adequate monitoring and appropriate follow-up procedures such as medication management. The occurrence of high PPA rates within a region or health care system may represent a failure of the ambulatory care system.
3M PPA can be useful to payers, employers, government agencies, researchers, integrated health delivery systems (e.g., managed care organizations and accountable care organizations), and residential nursing care facilities (e.g., nursing facilities, intermediate care facilities, and residential treatment centers).
For example, employers or government insurance programs can use 3M PPA to measure the performance of contracted, integrated health delivery systems or residential nursing care facilities. Those integrated health delivery systems and residential nursing care facilities themselves can also use the 3M PPA methodology to enhance their own performance by improving outcomes from year to year.
Here are a few examples of how the 3M PPA methodology has benefited customers.
3M PPA is integrated with other 3M patient classification methodologies.
3M PPA are available in the following 3M products:
Available to Licensees on the 3M Customer Support Website
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, 3M met this challenge by releasing the 3M™ Potentially Preventable Admission methodology 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 3M 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 3M PPA experience of a population is compared with the experience that would be expected for a population with the same case mix.
The 3M PPA logic is divided into two phases.
1. Identify patients with potentially preventable initial admissions
All inpatient stays are assigned to a 3M™ All Patient Refined Diagnosis Related Group (APR DRG). For the general population, approximately 41 base 3M APR DRGs are considered potentially preventable. For some 3M APR DRGs, the 3M PPA logic also takes into account individual diagnoses and patient age. In a Minnesota all-payer analysis, for example, the most common 3M PPAs were pneumonia, heart failure and COPD. [www.health.state.mn.us/healthreform/allpayer/potentially_preventable_events_072115.pdf] When an integrated health delivery system (such as a managed care organization or accountable care organization) accepts responsibility for a specific population, then additional 3M APR DRGs are considered potentially preventable, for a total of approximately 100. Examples of additional 3M 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 3M APR DRGs are considered potentially preventable, for a total of approximately 126. For example, 3M analysis showed that 3M APR DRG 720, Septicemia and Disseminated Infections, was the most common 3M PPA in a population of more than 400,000 Medicare nursing facility patients. [https://www.liebertpub.com/doi/10.1089/pop.2018.0065]
2. Determine patient risk adjustment
In any rate-based comparison of outcomes, risk adjustment is essential to a fair comparison across populations. Although 3M PPAs are generally preventable, they will never be totally eliminated, even with optimal care. As a result, there will be a residual rate of 3M PPAs in even the best-performing systems. More importantly, the rate at which 3M PPAs occur depends on the burden of illness of the population which is measured using 3M™ Clinical Risk Grouping (CRG) Software. For example, 3M 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., 3M CRG 70605).
Further information on the 3M PPA logic is available in the Population-focused Preventables Methodology Overview. Detailed information is available to licensees in the online PFP definitions manual.
The 3M PPA clinical logic is maintained by a team of 3M 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 3M enhancements to the clinical logic.
Learn more about 3M PPA
Please note that documents not published by 3M do not necessarily reflect 3M recommendations and have not been approved by 3M. These documents are listed here for the information of readers interested in the various ways that 3M patient classification methodologies have been applied. Also note that listing these references does not imply endorsement of 3M methodologies by individual authors, other organizations or government agencies.
This manual describes the 3M Population-focused Preventables (PFP) Software is a clinically-based classification system that identifies preventable hospital admissions, ED visits and ancillary services.
This e-Guide can help you understand 3M solutions for population health, patient safety and cost-effective care.
This article details the use of potentially preventable events and demonstrates how they are being applied to achieve health care value.
Texas Medicaid is emerging as a national leader in value-based purchasing and has produced exceptional results that clearly demonstrate the value proposition associated with alignment of financial incentives. This article presents several years of data and preliminary results of this effort.
This report explores one set of opportunities for health care system improvement and potential savings by analyzing Emergency Department (ED) visits, hospital admissions, and hospital readmissions to uncover the volume and make-up of potentially preventable health care events.