PARR-30 is a new tool developed by the Nuffield Trust for predicting which patients are most at risk of short-term readmission, designed to be used by acute hospitals.

Using data from the British Medical Journal (BMJ) Open article: Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30), by John Billings and others, this chart shows estimates (stratified by PARR-30 risk band) of how much can be spent on interventions to avoid readmission within 30 days, while still costing less than the readmission itself.

Unplanned hospital admissions and readmissions are regarded as markers of costly, suboptimal health care, and their avoidance is currently a priority for policy-makers in many countries. In England, Department of Health guidance for the NHS proposes that commissioners do not pay provider hospitals for emergency readmissions within 30 days of a planned admission.

The ability to identify patients at high risk of readmission, by using predictive risk models such as PARR-30, constitutes the first step in any strategy to improve care and services for susceptible patients.

The ultimate goal, however, is to couple this ‘case finding’ process with cost-effective interventions that mitigate the risk of readmission and ideally, use the ensuing financial savings to help fund the intervention.

This requires the sort of business case analysis presented in this chart, which documents the rate of readmissions and the maximum level of expenditure at each risk band (and at various risk band cut-off levels).

These values indicate where the cost of the preventive intervention is equal to the net savings from reduced readmissions – with various assumptions about the effectiveness of interventions (10 per cent, 15 per cent, and 20 per cent).

With a risk band cut-off of band 11, mean readmission costs were £1,088 per patient. Using an assumption of a 10 per cent reduction in the rate of readmission, £109 per patient could be spent on the 6,395 patients within these bands, with the costs of the intervention equaling the costs of avoided emergency admissions (break even).

Find out more about our work in this area by visiting the dedicated project page.

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