Potentially Preventable Hospitalizations — United States, 2001–2009
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| Supplement Volume 62, Supplement, No. 3 November 22, 2013 PDF of this issue | | |
Potentially Preventable Hospitalizations — United States, 2001–2009
Supplements
November 22, 2013 / 62(03);139-143
Corresponding author: Ernest Moy, Agency for Healthcare Research and Quality. Telephone: 301-427-1329; E-mail: Ernest.moy@ahrq.hhs.gov.
Introduction
Potentially preventable hospitalizations are admissions to a hospital for certain acute illnesses (e.g., dehydration) or worsening chronic conditions (e.g., diabetes) that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings. Although not all such hospitalizations can be avoided, admission rates in populations and communities can vary depending on access to primary care, care-seeking behaviors, and the quality of care available (1,2). Because hospitalization tends to be costlier than outpatient or primary care, potentially preventable hospitalizations often are tracked as markers of health system efficiency. The number and cost of potentially preventable hospitalizations also can be calculated to help identify potential cost savings associated with reducing these hospitalizations overall and for specific populations.This report is part of the second CDC Health Disparities and Inequalities Report (CHDIR). The 2011 CHDIR (2) was the first CDC report to assess disparities across a wide range of diseases, behavior risk factors, environmental exposures, social determinants, and health-care access. The topic presented in this report is based on criteria that are described in the 2013 CHDIR Introduction (3). This report updates information on potentially preventable hospitalizations that was presented in the first CHDIR (4). The purposes of this report are to discuss and raise awareness of differences in the race/ethnicity and income of persons with excess potential preventable hospitalizations and to prompt actions to reduce these disparities.
Methods
To examine trends in a composite measure of potentially preventable hospitalizations among adults aged ≥18 years in the United States, the Agency for Healthcare Research and Quality (AHRQ) analyzed data for 2001–2009 from the Healthcare Cost and Utilization Project (HCUP) databases (available at http://www.ahrq.gov/research/data/hcup/index.html
). HCUP databases combine the data-collection efforts of state data organizations, hospital associations, private data organizations, and the federal government to create a national information resource of discharge-level health-care data. HCUP includes the largest collection of longitudinal hospital care data in the United States with all-payer, encounter-level information, beginning with 1988. Numbers of potentially preventable hospitalizations in 2009 were estimated by race/ethnicity and income quartile for the following eight conditions: diabetes, hypertension, congestive heart failure, angina without procedure, asthma, dehydration, bacterial pneumonia, and urinary infections. Hospitalizations include all inpatient stays with these conditions listed as the principal diagnosis regardless of admitting source (e.g., admissions through an emergency room, transfers from other facilities, and direct admissions by a provider). Because coding of race/ethnicity varies across state hospital databases, analyses by race/ethnicity used a specially created 40% sample of hospitals from states that contribute comparable race/ethnicity data to HCUP (concerning approximately 16 million discharges from 2,000 hospitals in 36 states in 2009) (5). Race was classified as non-Hispanic white, non-Hispanic black, Asian/Pacific Islander (A/PI), and other. Ethnicity was classified as Hispanic and non-Hispanic. Persons of Hispanic ethnicity might be of any race or combination of races. Area income, based on the income of the neighborhood in which a patient lives, was used as a proxy for socioeconomic status. Area income was divided into quartiles on the basis of the mean household income by the patient's ZIP Code. Quartile 1 refers to the lowest income communities, and quartile 4 refers to the wealthiest communities. Analyses by area income used the Nationwide Inpatient Sample, a nationally stratified 20% sample of hospitals from states that contribute data to HCUP (concerning approximately 8 million discharges from 1,000 hospitals in 44 states in 2009). Data regarding patients' educational attainment or disability status were unavailable or insufficient to provide estimates for certain populations (i.e., American Indians/Alaska Natives, Native Hawaiians and Other Pacific Islanders, and persons of multiple races). Data on disparities related to sex and geographic location are not presented but are available at http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr11/index.html#Efficiency
. Disparities in hospital admission rates per 100,000 population for 2001–2009 were estimated, and potential cost savings related to income and race/ethnicity were examined. Hospitalization rates for the potentially preventable conditions were calculated by using the AHRQ Prevention Quality Indicators (PQIs) modified version 4.2, which were adjusted by age and gender on the basis of the 2000 U.S. standard population (5). Excess potentially preventable hospitalizations by area income were estimated by comparing the 2009 AHRQ PQI composite rate of hospitalizations for residents of the neighborhoods in the highest income quartile, the group with the lowest rate, with the composite rate for residents of neighborhoods in lower income quartiles. Similarly, excess potentially preventable hospitalizations by race/ethnicity were estimated by comparing the 2009 AHRQ PQI composite rate of hospitalizations for A/PIs, the group with the lowest rate, with the composite rate for other racial/ethnic groups. Total charges included on hospital claims were converted to costs by using hospital-level cost-to-charge ratios based on the Centers for Medicare and Medicaid Services' (CMS) hospital cost report data (5). Costs associated with potentially preventable hospitalizations were estimated by multiplying numbers of excess hospitalizations for a group by the average cost per hospitalization for that group. Costs are for the hospital cost of producing the services and do not include physician costs associated with hospital stay.
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