Open Access Highly Accessed Research article

Manual and automated methods for identifying potentially preventable readmissions: a comparison in a large healthcare system

Ana H Jackson1*, Emily Fireman1, Paul Feigenbaum2, Estee Neuwirth1, Patricia Kipnis3 and Jim Bellows1

Author Affiliations

1 Care Management Institute, Kaiser Permanente, Oakland, California, USA

2 The Permanente Medical Group, Oakland, California, USA

3 Management Information and Analysis, Kaiser Permanente Northern California, Oakland, California, USA

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BMC Medical Informatics and Decision Making 2014, 14:28  doi:10.1186/1472-6947-14-28

Published: 5 April 2014



Identification of potentially preventable readmissions is typically accomplished through manual review or automated classification. Little is known about the concordance of these methods.


We manually reviewed 459 30-day, all-cause readmissions at 18 Kaiser Permanente Northern California hospitals, determining potential preventability through a four-step manual review process that included a chart review tool, interviews with patients, their families, and treating providers, and nurse reviewer and physician evaluation of findings and determination of preventability on a five-point scale. We reassessed the same readmissions with 3 M’s Potentially Preventable Readmission (PPR) software. We examined between-method agreement and the specificity and sensitivity of the PPR software using manual review as the reference.


Automated classification and manual review respectively identified 78% (358) and 47% (227) of readmissions as potentially preventable. Overall, the methods agreed about the preventability of 56% (258) of readmissions. Using manual review as the reference, the sensitivity of PPR was 85% and specificity was 28%.


Concordance between methods was not high enough to replace manual review with automated classification as the primary method of identifying preventable 30-day, all-cause readmission for quality improvement purposes.

Qualitative research; Quality assurance; Health care/methods; Patient readmission/statistics & numerical data