title: Physician consensus on preventability and predictability of readmissions based on standard case scenarios.
abstract: BACKGROUND
  Policy makers struggle with unplanned readmissions as a quality indicator since integrating preventability in such indicators is difficult. Most studies on the preventability of readmissions questioned physicians whether they consider a given readmission to be preventable, from which conclusions on factors predicting preventable readmissions were derived. There is no literature on the interobserver agreement of physician judgement.
  
  
  OBJECTIVE
  To assess the degree of agreement among physicians regarding predictability and preventability of medical readmissions.
  
  
  METHODS
  An online survey based on eight real-life case scenarios was distributed to European physicians.
  
  
  METHODS
  Physicians were requested to rate from the first four (index admission) scenarios whether they expected these patients to be readmitted within 30 days (the predictability). The remaining four cases, describing a readmission, were used to assess the preventability. The main outcome was the degree of agreement among physicians determined using the intra class correlation coefficient (ICC).
  
  
  RESULTS
  526 European medical physicians completed the survey. Most physicians had internal medicine as primary specialism. The median years of clinical experience was 11. ICC for predictability of readmission was 0.67 (moderate to good) and ICC for preventability of readmission was 0.13 (poor).
  
  
  CONCLUSIONS
  There was moderate to good agreement among physicians on the predictability of readmissions while agreement on preventability was poor. This study indicates that assessing preventability of readmissions based solely on the judgement of physicians is far from perfect. Current literature on the preventability of readmissions and conclusions derived on the basis of physician opinion should be interpreted with caution.
authors.affiliation: Department of Internal Medicine, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: L S
authors.initials: LS
authors.lastname: van Galen
authors.forename: T
authors.initials: T
authors.lastname: Cooksley
authors.forename: H
authors.initials: H
authors.lastname: Merten
authors.forename: M
authors.initials: M
authors.lastname: Brabrand
authors.forename: C B
authors.initials: CB
authors.lastname: Terwee
authors.forename: C
authors.initials: C
authors.lastname: H Nickel
authors.forename: C P
authors.initials: CP
authors.lastname: Subbe
authors.forename: R
authors.initials: R
authors.lastname: Kidney
authors.forename: J
authors.initials: J
authors.lastname: Soong
authors.forename: L
authors.initials: L
authors.lastname: Vaughan
authors.forename: I
authors.initials: I
authors.lastname: Weichert
authors.forename: M H H
authors.initials: MH
authors.lastname: Kramer
authors.forename: P W B
authors.initials: PW
authors.lastname: Nanayakkara
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D003697:Delphi Technique; D003718:Denmark; D005260:Female; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010359:Patient Readmission; D010820:Physicians; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D013557:Switzerland; D006113:United Kingdom; D055815:Young Adult