Potentially Preventable Hospitalizations Research Articles

Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study.

To evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls. Using 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level. People with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls. People with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.

Reducing Rural and Urban Disparities in Potentially Preventable Hospitalizations: Evidence of Hospital-Based Health Information Technology and Enabling Services.

Background: Telehealth and enabling services are promising approaches to address the intersecting challenges of chronic disease burden, a growing aging population, and poor access to care disproportionately affecting rural areas. Using potentially preventable hospitalizations (PPHs) as an indicator for health system efficiency and quality, this study examined the relationship between health information technology and hospital-provided enabling services on PPHs across rural, micropolitan, and metropolitan areas. Methods: We constructed a patient-, hospital-, community-, and state-level data set using the Medicare fee-for-service claims file and the Medicare Master Beneficiary Summary File, and the American Hospital Association Annual Survey. Logistic regressions were applied to examine associations between PPH and telehealth post-discharge, telehealth treatment, and telehealth post-discharge and enabling services. Results: Approximately 50% of rural and micropolitan residents (vs. 36% of urban residents) were treated in hospitals providing neither telehealth post-discharge services nor enabling services, and 7% (vs. 11% of urban residents) were treated in hospitals with both services. Telehealth post-discharge services were associated with significantly lower odds ratio (OR) of having any PPH due to acute (OR = 0.91, p < 0.001) and chronic conditions (OR = 0.94, p < 0.001). The ORs of having any PPH due to acute and chronic conditions were the least among beneficiaries who were treated in hospitals with both telehealth post-discharge and enabling services (OR = 0.56, p < 0.001, for acute conditions, and OR = 0.73, p < 0.001, for chronic conditions). Conclusions: Hospital use of post-discharge telehealth alongside enabling services may help provide timely access to care, improve care coordination, and reduce PPHs for older rural residents.

Rural/Urban Disparities in PQIs Among Patients with ADRD – Evidence of Hospital‐based HIT and Enabling Services

AbstractBackgroundTo examine urban and rural disparities in potentially preventable hospitalizations (PPH) among patients with Alzheimer’s Disease and Related Dementias (ADRD) and the use of health information technology (HIT) and enabling services as mediators.MethodWe merged 2017 100% Medicare Fee‐For‐Service (FFS) claims with the Medicare Beneficiary Summary File, American Community Survey, and American Hospital Association Annual Survey to construct a dataset containing patient, hospital, and community‐level data. Logistic regression was applied to examine differences in PPH by HIT and enabling services.ResultThe rates of PPHs related to acute and chronic conditions for rural and micropolitan patients with ADRD were significantly higher compared to the rates among urban patients with ADRD. Having both telehealth post‐discharge and enabling services significantly decreases the odds of PPH due to acute (OR: 0.93, 95% CI: 0.89‐0.98, p‐value &lt;0.01) and chronic conditions (OR: 0.96, 95% CI: 0.92‐1.00, p‐value = 0.07) compared to not having these available. The presence of both telehealth post‐discharge and enabling services significantly decreased the odds of PPH in patients with ADRD in rural (acute PPH OR: 0.56, 95% CI: 0.41‐0.77, p‐value &lt;0.01; chronic PPH OR: 0.73, 95% CI: 0.55‐0.97, p‐value = 0.03) and micropolitan (acute PPH OR: 0.65, 95% CI: 0.57‐0.73, p‐value &lt;0.01; chronic PPH OR: 0.83, 95% CI: 0.74‐0.93, p‐value &lt;0.01) areas compared to urban patients with ADRD.ConclusionResults suggest that the combination of HIT telehealth post‐discharge and enabling services are important interventions in helping to reduce preventable hospitalizations among patients with ADRD living in rural and micropolitan areas.

Potentially Preventable Hospitalizations Among Adults With Pediatric-Onset Disabilities

ObjectiveTo examine the risk of any and specific potentially preventable hospitalizations (PPHs) for adults with cerebral palsy (CP) or spina bifida (SB). We hypothesize that PPH risk is greater among adults with CP/SB compared with the general population. Patients and MethodsUsing January 1, 2007, to December 31, 2017, national private administrative claims data (OptumInsight) in the United States, we identified adults with CP/SB (n=10,617). Adults without CP/SB were included as controls (n=1,443,716). To ensure a similar proportion in basic demographics, we propensity-matched our controls with cases in age and sex (n=10,617). Generalized estimating equation models were applied to examine the risk of CP/SB on PPHs. All models were adjusted for age, sex, race/ethnicity, health indicators, US Census Division data, and socioeconomic variables. Adjusted odds ratios were compared within a 4-year follow-up. ResultsAdults with CP/SB had higher risk for any PPH (odds ratio [OR], 4.10; 95% CI, 2.31 to 7.31), and PPHs due to chronic obstructive pulmonary disease/asthma (OR, 1.85; CI, 1.23 to 2.76), pneumonia (OR, 3.01; 95% CI, 2.06 to 4.39), and urinary tract infection (OR, 6.48; 95% CI, 3.91 to 10.75). Cases and controls who had an annual wellness visit had lower PPH risk (OR, 0.52; 95% CI, 0.41 to 0.67); similarly, adults with CP/SB who had an annual wellness visit compared with adults with CP/SB who did not had lower odds of PPH (OR, 0.75; 95% CI, 0.60 to 0.94). ConclusionAdults with pediatric-onset disabilities are at a greater risk for PPHs. Providing better access to preventive care and health-promoting services, especially for respiratory and urinary outcomes, may reduce PPH risk among this patient population.

Risk factors for unanticipated hospitalizations in children and youth with spina bifida at an urban children’s hospital: A cross-sectional study

BackgroundSpina bifida (SB) is a condition resulting from the improper closure of the neural tube and vertebral column during fetal development. While patients’ life expectancy and quality of life have improved dramatically due to medical advances, children continue to experience health-related issues that often require hospitalizations. ObjectiveThe association among sociodemographic and clinical characteristics with potentially preventable hospitalizations (PPH) in children and youth with myelomeningocele type SB was investigated in this cross-sectional study. MethodsChart reviews and data extraction were conducted on 108 children and youth, ages 1 month to 21 years, admitted for PPH in a regional children's academic medical center between May 2017 and July 2019.Sociodemographic variables included sex, age, type of insurance and ethnicity. Clinical variables included level of lesion, ambulation status, shunt dependency and selected diagnostic categories. Univariate, bivariate, and multivariate analyses were conducted to identify factors associated with PPH. ResultsFactors associated with PPH included being male, ages 5–18 years, low lumbar level lesions, non-ambulatory, with public insurance, Hispanic and shunt dependent. Most hospitalizations (73%) were for neurologic or urologic conditions. Factors independently associated with PPH were ethnicity for urologic conditions, being ambulatory for metabolic conditions, and age for gastroenterology conditions. ConclusionSelected demographic and clinical variables were found to be associated with PPH of children and youth with myelomeningocele-type SB. The most common reasons for PPH were shunt malfunctions and urinary tract infections, consistent with other studies.

Rural and urban disparities in potentially preventable hospitalizations among US patients with Alzheimer's Disease and Related Dementias: Evidence of hospital-based telehealth and enabling services

We examined urban and rural disparities in potentially preventable hospitalizations (PPHs) among US patients with Alzheimer's Disease and Related Dementias (ADRD) and the use of telehealth post-discharge and enabling services as mediators. We merged 2017 100% Medicare Fee-For-Service (FFS) claims with the Medicare Beneficiary Summary File, along with population and hospital-based characteristics. Logistic regression models were employed to examine differences in PPHs by telehealth and enabling services. The rates of PPHs related to acute and chronic conditions for patients with ADRD living in rural and micropolitan areas were significantly higher compared to patients with ADRD in urban areas. Telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs associated with acute (OR: 0.93, 95% CI: 0.89–0.98, P-value <0.01) and chronic conditions (OR: 0.96, 95% CI: 0.92–1.00, P-value = 0.07). In addition, telehealth post-discharge combined with enabling services significantly decreased the odds of PPHs in patients with ADRD in rural (acute PPHs OR: 0.56, 95% CI: 0.41–0.77, P-value <0.01; chronic PPHs OR: 0.73, 95% CI: 0.55–0.97, P-value = 0.03) and micropolitan (acute PPHs OR: 0.65, 95% CI: 0.57–0.73, P-value <0.01; chronic PPHs OR: 0.83, 95% CI: 0.74–0.93, P-value <0.01) areas. Our results suggest that the combinations of telehealth post-discharge and enabling services are important interventions in helping to reduce preventable hospitalizations among patients with ADRD living in rural and micropolitan areas.

Potentially preventable hospitalizations and use of preventive services among people with multiple sclerosis: Large cohort study, USA

BackgroundIndividuals with multiple sclerosis (MS) report barriers to accessing care, including receipt of preventive services. Potentially preventable hospitalization (PPH) is an important marker for access to, and receipt of timely care. However, few national studies have examined PPH risk in people with MS or considered the role of preventive care in reducing PPH risk among this patient population. Our objective was to examine PPH risk among adults with MS compared with their counterparts without MS. MethodsOptum® Clinformatics® Data Mart (2007–2017) was used to identify 6198 individuals with an MS diagnosis and their propensity-score matched counterparts without MS. Diagnostic and procedural codes were used to identify the presence of preventive hospitalizations, which were defined as quality indicators by the Agency for Healthcare Research and Quality (AHRQ) during the 4-year follow-up period since the diagnosis of MS. Information on receipt of preventive services and office visits was also extracted. Adjusted generalized estimating equations were used to examine the association between MS diagnosis and PPHs. To examine the role of preventive services on odds of PPH amongst people with MS, we reported the adjusted marginal odds ratio (OR) and 95% confidence intervals (CI). ResultsThe rate of any PPH among people with MS was double that of those without MS (131.6 vs 62.5 per 10,000). We identified higher odds of specific PPH indicators among people with MS compared to those without. Individuals with MS had 65% higher odds of hospitalization for pneumonia (OR=1.65, 95% CI: 1.01, 2.30), with similar significant findings observed for urinary tract infections (OR=4.90, 95% CI: 2.51, 9.57). In MS patients, receipt of preventive services, namely cholesterol screening (OR=0.76, 95% CI: 0.60, 0.95) and annual wellness visits were associated with lower odds of any PPH (OR=0.57, 95% CI: 0.43, 0.76). ConclusionPeople with MS were at a higher risk for PPHs compared with their counterparts without MS. Use of appropriate preventive services reduced the risk of PPH among the general population and among those with MS. More efforts are needed to encourage and facilitate the use of preventive care among people with MS. Receipt of timely and appropriate preventive care in this population may reduce the risk for PPH.

Preventative Services Use and Risk Reduction for Potentially Preventative Hospitalizations Among People With Traumatic Spinal Cord Injury

ObjectiveTo examine the risk of potentially preventable hospitalizations (PPHs) for adults (18 years or older) with traumatic spinal cord injury (TSCI) to identify the most common types of preventable hospitalizations and their associative risk factors. DesignCohort study. SettingUsing 2007-2017 U.S. claims data from the Optum Clinformatics Data Mart, we identified adults (18 years or older) with diagnosis of TSCI (n=5380). Adults without TSCI diagnosis were included as controls (n=1,074,729). Using age and sex, we matched individuals with and without TSCI (n=5173) with propensity scores to address potential selection bias. Generalized linear regression was applied to examine the risk of TSCI on PPHs. Models were adjusted for age; sex; race and ethnicity; Elixhauser comorbidity count; any cardiometabolic, psychological, and musculoskeletal chronic conditions; U.S. Census Division; socioeconomic variables; and use of certain preventative care services. Adjusted odds ratios were compared within a 4-year follow-up period. ParticipantsAdults with and without TSCI (N=5,173). InterventionNot applicable. Main Outcomes MeasuresAny PPH and specific PPHs ResultsAdults with TSCI had higher risk for any PPH (odds ratio [OR], 1.67; 95% CI,1.20-2.32), as well as PPHs because of urinary tract infection (UTI) (OR, 3.78; 95% CI, 2.47-5.79), hypertension (OR, 3.77; 95% CI, 1.54-9.21), diabetes long-term complications (OR, 2.54; 95% CI, 1.34-4.80), and pneumonia (OR, 1.71; 95% CI. 1.21-2.41). Annual wellness visit was associated with reduced PPH risk compared with cases and controls without annual wellness visit (OR, 0.57; 95% CI, 0.46-0.71) and among people with TSCI (OR, 0.69; 95% CI, 0.55-0.86) compared with cases without annual wellness visit. ConclusionsAdults with TSCI are at a heightened risk for PPH. They are also more susceptible to certain PPHs such as UTIs, pneumonia, and heart failure. Encouraging the use of preventative or health-promoting services, especially for respiratory and urinary outcomes, may reduce PPHs among adults with TSCI.

Socio-economic disparities in the appropriateness of diabetes care in an Italian region: findings of AEQUITAS study

&#x0D; Background: To evaluate socio-economic disparities in diabetes prevalence and care in Marches (a region of central Italy) in 2003-2010 through a cross-sectional study.&#x0D; Methods: The databases of 52 general practitioners were mined for people with diabetes (age ≥20 years). These data were linked with records from other regional administrative databases. Healthcare disparities, specifically potentially preventable hospitalizations (PPH) related to diabetes and its complications, were analysed using participants’ gender, age, and education data and the Italian Deprivation Index. Crude, age-specific and gender-specific diabetes prevalence was estimated for each year of observation. A time-trend analysis was performed. Admissions that might have been prevented according to Agency for Healthcare Research and Quality criteria were used to calculate the PPH rate for each level of social condition indicators. Rate ratios and 95% confidence intervals were estimated with a multiple Poisson regression model.&#x0D; Results: The search found 6,494 participants with diabetes mellitus aged ≥20 years. Disease prevalence ranged from 5.4% (2003) to 7.8% (2010), with a significant 0.31% positive trend. Those aged ≤44 years were at significantly higher risk of PPH than older people. A significant PPH excess was found among people living in socio-economically disadvantaged areas. Education and gender did not significantly affect PPH.&#x0D; Conclusion. People with diabetes seem to use primary care services appropriately irrespective of socio-economic status. Outpatient services are not equally distributed on the regional territory; this may increase disease severity and/or the risk of diabetes complications and affect appropriateness of diabetes care.&#x0D;

Examining the Risk of Potentially Preventable Hospitalization in Adults With Congenital and Acquired Disabilities

Physical distancing and restriction of movements as measures to prevent the spread of Covid-19 required people to change their work, home and social lives. Loneliness and social isolation have emerged as key public health issues during the pandemic. Traditionally when considering loneliness the focus is often on individual factors rather than within the context of structural and environmental dimensions. This paper will utilise data from the Coping with Loneliness, Isolation and Covid-19 global online survey which had over 20, 000 global responses from people aged 18+ in 2020. Analysis will use the lens of ‘place’ and the 5-item UCLA scale and 6-item Lubben social network scale to understand the social and demographic characteristics and structural and environmental factors associated with those experiencing loneliness and/or social isolation in rural and urban areas both before and during the pandemic. The paper will conclude with key messages from a public health perspective.

Examining the Risk of Potentially Preventable Hospitalization in Adults with Congenital and Acquired Disabilities

<h3>Research Objectives</h3> Adults with congenital (cerebral palsy/spina bifida (CP/SB)) or acquired disabilities (spinal cord injury (SCI) or multiple sclerosis (MS)) are more likely than those without disability to develop medical complications. Little is known about potentially preventable hospitalizations (PPH) among adults with disabilities. PPHs are preventable if a patient had timely access to care. Our objective was to estimate PPH risk for each of the aforementioned disabilities. <h3>Design</h3> Logistic regression models with repeated measures were subsequently applied, adjusting for age, sex, race/ethnicity, health indicators, U.S. census divisions, and socioeconomic variables. Odd ratios (OR) were compared over 4-years of follow up. <h3>Setting</h3> We used private payer claims data from 2007-2017 to identify adults (18+) with diagnoses of CP/SB (n=10,617), SCI (n=5,173), and MS (n=6,198). Adults without these disabilities were included as controls.We propensity score matched individuals for age and sex. Logistic regression models with repeated measures were subsequently applied, adjusting for age, sex, race/ethnicity, health indicators, U.S. census divisions, and socioeconomic variables. <h3>Participants</h3> Adults (18+) with diagnoses of CP/SB (n=10,617), SCI (n=5,173), and MS (n=6,198). <h3>Interventions</h3> Use of preventative services and their interactions with our exposure variable (specific disability type). <h3>Main Outcome Measures</h3> Risk and cost of potentially preventable hospitalization. <h3>Results</h3> Adults with CP/SB, SCI, and MS had higher odds of any PPH compared with adults without disability [CP/SB: (OR=4.10; 95% CI: 2.31-7.31); SCI: (OR=1.67; 95% CI: 1.21-2.32); and MS: (OR=1.48; 95% CI: 1.00-2.25)]. Use of preventative services reduced the PPH risk. For example, wellness visit reduced the odds of PPH by almost half [CP/SB: (OR=0.52; 95% CI: 0.41-0.67); SCI: (OR=0.57; 95% CI: 0.45-0.71); and MS: (OR=0.53; 95% CI: 0.40-0.66)]. <h3>Conclusions</h3> Adults with disabilities are at greater odds of PPH compared to adults without disabilities. Clinical guidelines for use of preventative care for adults living with disabilities need to be accordingly updated. <h3>Author(s) Disclosures</h3> There is no conflict of interest to disclose.

6-OR: Psychological Comorbidities and Racial/Ethnic Disparities in Preventable Hospitalizations among Medicaid-Enrolled Adults with Type 2 Diabetes

Background: Among adults with type 2 diabetes, racial and ethnic minorities have significantly higher rates of potentially preventable hospitalizations (PPH) compared to White non-Hispanic adults. Depression, anxiety, and stress-related disorders are associated with increased risk of diabetes related PPH. We examined the interaction of these risk factors among Medicaid enrollees. Methods: This study used 2014 Medicaid claims data from 17 US states. The sample included 1,049,790 adults with type 2 diabetes. The outcome was &amp;gt;=1 diabetes related PPH, defined by the AHRQ Prevention Quality Diabetes Composite measure. Predictors were race/ethnicity and mental health diagnoses (PTSD, adjustment disorder, generalized anxiety disorder [GAD], phobic disorders, and depressive disorders). Logistic regression models examined the adjusted main-effects and interactions of both predictors on PPH, adjusting for clinical and demographic characteristics. Results: Depression was associated with significantly greater odds of PPH (Adjusted Odds Ratio [AOR] = 1.50, 95%CI: 1.47, 1.60). PTSD (AOR = 0.81, 95%CI: 0.69, 0.96) and GAD (AOR = 0.79, 95%CI: 0.68, 0.92) were associated with lower odds of PPH. Black adults had significantly higher odds of PPH (AOR = 1.30, 95%CI: 1.26, 1.34) and Hispanic adults had significantly lower odds of PPH (AOR = 0.95, 95%CI: 0.91, 0.99) compared to White non-Hispanic adults. Depression increased odds of PPH among Black adults (AOR = 1.09, 95%CI: 1.03, 1.16) and decreased odds of PPH among Hispanic adults (AOR = 0.87, 95%CI: 0.79, 0.96) compared to White non-Hispanic adults. Discussion: Of the psychological comorbidities examined, only depression was associated with increased risk of diabetes related PPH. Results suggest that depressive symptoms may exacerbate racial and ethnic disparities in PPH. Adults with PTSD or GAD diagnoses may have greater engagement with preventive healthcare and thus, lower risk of PPH. Disclosure A. A. Lee: None. Y. Zhang: None. S. Ramachandran: None.

Incident Dementia, Glycated Hemoglobin (HbA1c) Levels, and Potentially Preventable Hospitalizations in People Aged 65 and Older With Diabetes.

This study was aimed to determine whether incident dementia and HbA1c levels are associated with increased rates of potentially preventable hospitalizations (PPHs) in persons with diabetes. A total of 565 adults aged 65+ ever treated for diabetes were enrolled from Adult Changes in Thought study. PPHs were from principal discharge diagnoses and included diabetes PPH (dPPH), respiratory PPH (rPPH), urinovolemic PPH (uPPH), cardiovascular PPH, and other PPH. Poisson generalized estimating equations estimated rate ratios (RRs) and 95% confidence intervals (CIs) for the associations between dementia or HbA1c measures and rate of PPHs. A total of 562 individuals contributed 3 602 dementia-free years, and 132 individuals contributed 511 dementia follow-up years. One hundred twenty-eight (23%) dementia-free individuals had 210 PPH admissions and a crude rate of 58 per 1 000 person-years, while 55 (42%) individuals with dementia had 93 PPH admissions and a crude rate of 182 per 1 000 person-years. The adjusted RR (95% CI) comparing rates between dementia and dementia-free groups were 2.27 (1.60, 3.21) for overall PPH; 5.90 (2.70, 12.88) for dPPH; 5.17 (2.49, 10.73) for uPPH; and 2.01 (1.06, 3.83) for rPPH. Compared with HbA1c of 7%-8% and adjusted for dementia, the RR (95% CI) for overall PPH was 1.43 (1.00, 2.06) for >8% HbA1c and 1.18 (0.85, 1.65) for <7% HbA1c. The uPPH RR was also increased, comparing >8% and <7% HbA1c levels. Incident dementia is associated with higher rates of PPHs among people with diabetes, especially PPHs due to diabetes, urinary tract infection (UTI), and dehydration. Potential evidence suggested that HbA1c levels of >8% versus lower levels are associated with higher rates of overall PPHs and UTI- and dehydration-related PPHs.

Social networks in patients hospitalized with preventable conditions for heart disease and diabetes in Hawai'i by health literacy.

Reducing potentially preventable hospitalizations (PPH) for chronic disease is a research and practice priority. Native Hawaiians and other Pacific Islanders (NHOPI) have disparities in PPH, and are understudied in both health literacy and social network research. Greater inclusion of social and familial networks can help address health disparities among people with chronic illness and enhance culturally relevant healthcare. Adults hospitalized with a heart disease or diabetes-related PHH in Hawai'i (N = 22) were assessed for health literacy and social network membership ("alters"). Sixty-nine percent of respondents were NHOPI. Three respondents (14%) had no alters ("isolates"). Among non-isolates, 79% desired the participation of at least one alter in chronic disease management-related interventions. Fifty-nine percent of respondents had low health literacy. While the mean number of alters did not vary significantly by health literacy, those with lower health literacy had a trend (p = .055) towards less interest in social network engagement. In a sample primarily comprised of NHOPI with chronic disease, many patients wished to include social network members in interventions. Engagement varied by health literacy with implications for health disparities. Not all patients were interested in social network engagement, which must be considered in intervention planning.

Estimates of potentially preventable hospitalizations for ambulatory care sensitive conditions in Ukraine

The purpose: this study aims to identify the most relevant diseases that can be treated outpatient (Ambulatory Care Sensitive Conditions, or ACSCs) and to define the scope of potentially preventable hospitalizations (PPHs) for such conditions (Ambulatory Care Sensitive Hospitalizations, or ACSH), for Ukrainian adults (above 18 years old), subject to improvement of primary care efficiency. The study has been carried out in four phases, using the World Health Organization’s (WHO) guidance on ACSCs for the European Region, which was adapted to the national context. The data was taken from the official statistical reporting and analyzed by 104 reviewers. The assessment of the PPHs is conducted based on responses of the subgroup of reviewers – 6 experts and 61 primary care physicians, which confirmed the levels of competencies. The most significant rates of potentially preventable hospitalizations (PPHs) are registered for hypertension, pneumonia, angina, chronic obstructive pulmonary disease (COPD), and diabetes, which coincide with ACSCs that are most prevalent for Ukrainian adults. The overall rate of PPHs for adult population of Ukraine with ACSCs is 28.2% as defined by physicians and 32.9% as defined by experts, which may reduce the hospitalization rate for all ACSCs (as percent of all patients with ACSCs) from 8.2% to 6.1% (according to reviews of physicians) or to 5.7% (according to experts’ reviews). The study has shown an important scope for better managing of ACSCs in Ukrainian adults. The results of the study can be used to inform the continued health system transformation, specifically for the development of interventions to prevent avoidable hospitalizations for ACSCs in Ukraine, which can lead to more efficient use of resources in the health system and further strengthening of the primary care.

Potentially Preventable Hospitalizations for Chronic Conditions among Youth

Abstract Objective Chronic, preventable conditions like diabetes and hypertension previously seen primarily in adults are increasing among young people. Chronic disease-related potentially preventable hospitalizations (PPH) are costly. The study goal was to quantify potentially preventable hospitalizations (PPH) for chronic disease in those aged 5-29 years in one diverse state of the USA. Methods With Hawai'i statewide inpatient 2015-2016 data across all payers, we used standard metrics to capture asthma, diabetes, and hypertension PPH. Denominators were obtained by age group, gender, race/ethnicity, and living in O'ahu vs. other Hawaiian Islands from American Community Survey data. A multivariable negative binomial regression model predicted having a PPH adjusting for age group, gender, race/ethnicity, and O'ahu residency. Results Six percent (775) of inpatient hospitalizations among young people, representing 455 unique individuals, were PPH for a chronic disease. The types of PPH inpatient hospitalizations include diabetes (436), asthma (261), heart disease (64) and hypertension (14). The number of PPH visits per individual ranged from 1-20 with a mean of 1.7 (SD: 2.28) visits. The total cost of these PPH during this 2-year time period was $16,762,262. Among unique individuals with a chronic disease PPH (N = 455), the mean age was 17.5 (SD: 8.2); 55% were male. In the multivariable model, those who were between 10-14 years (RR:0.47;0.32-0.69) and 15-19 years (RR:0.46;0.31-0.69) were significantly less likely to have a PPH compared to those aged 5-9 years. Other Pacific Islanders were significantly more likely to have a PPH (RR: 3.08; 2.05-4.63) compared to whites. Conclusions Many hospitalizations by those aged 5-29 years were PPH. Pacific Islander youth had PPH chronic disease disparities. Chronic disease prevention and management is critical. Solutions may include equitable chronic disease prevention policies and improving access to culturally relevant care. Key messages This study reveals important disparities in youth that may lead to future health risks as well as current poor outcomes. Other Pacific Islanders were at significantly increased risk for PPH for chronic disease compared to other racial/ethnic groups from early childhood to young adulthood.

PMH42 ACOS AND PREVENTABLE HOSPITALIZATIONS AMONG PATIENTS WITH DEPRESSION

Accountable care organizations (ACOs) have been successful in improving quality of care but little is known about who is benefitting from ACOs and through what mechanism. This study examines variation of potentially preventable hospitalizations (PPHs) for chronic conditions with co-existing depression in adults by hospital ACO affiliation and care coordination strategies by race/ethnicity.

Behavioral health conditions and potentially preventable diabetes-related hospitalizations in the United States: Findings from a national sample of commercial claims data.

ObjectiveTo characterize the relationship between potentially preventable hospitalizations (PPHs) for diabetes and behavioral health conditions in commercially insured working-age persons with diabetes in the United States.Research design and methodsWe retrospectively analyzed medical and pharmacy claims from services rendered between 2011 and 2013 for 229,039 adults with diabetes. Diabetes PPHs were identified using the Agency for Healthcare Research and Quality’s Prevention Quality Indicators v6.0 logic. We used negative binomial-logit hurdle regression models to explore the adjusted relationships between diabetes PPHs and schizophrenia, bipolar, depression, anxiety, adjustment disorder, alcohol use disorder, and drug use disorder.ResultsA total of 4,521 diabetes PPHs were experienced by 3,246 of the persons in the sample. The 20.83% of persons with one or more behavioral health conditions experienced 43.62% (1,972/4,521; 95% CI 42.18%-45.07%) of all diabetes PPHs, and the 7.14% of persons with more than one diagnosed behavioral health condition experienced 24.77% (1,120/4,521; 95% CI 23.54%-26.05%) of all diabetes PPHs. After adjusting for sociodemographic and physical health covariates, patients with depression, schizophrenia, drug or alcohol use disorders, or multiple behavioral health conditions were at significantly increased risk of experiencing at least one diabetes PPH, while patients with depression, drug use disorder, or multiple behavioral health conditions were at significantly increased risk of experiencing recurring diabetes PPHs over time.ConclusionsA number of behavioral health conditions are associated with diabetes PPHs, which are often preventable with timely, high-quality outpatient care. The results of this study will enable clinicians, payers, and policy-makers to better focus outpatient care interventions and resources within the population of persons with diabetes.

Anticipatory Care in Potentially Preventable Hospitalizations: Making Data Sense of Complex Health Journeys.

Purpose: Potentially preventable hospitalizations (PPH) are minimized when adults (usually with multiple morbidities ± frailty) benefit from alternatives to emergency hospital use. A complex systems and anticipatory journey approach to PPH, the Patient Journey Record System (PaJR) is proposed.Application: PaJR is a web-based service supporting ≥weekly telephone calls by trained lay Care Guides (CG) to individuals at risk of PPH. The Victorian HealthLinks Chronic Care algorithm provides case finding from hospital big data. Prediction algorithms on call data helps optimize emergency hospital use through adaptive and anticipatory care. MonashWatch deployment incorporating PaJR is conducted by Monash Health in its Dandenong urban catchment area, Victoria, Australia.Theory: A Complex Adaptive Systems (CAS) framework underpins PaJR, and recognizes unique individual journeys, their dependence on historical and biopsychosocial influences, and difficult to predict tipping points. Rosen's modeling relationship and anticipation theory additionally informed the CAS framework with data sense-making and care delivery. PaJR uses perceptions of current and future health (interoception) through ongoing conversations to anticipate possible tipping points. This allows for possible timely intervention in trajectories in the biopsychosocial dimensions of patients as “particulars” in their unique trajectories.Evaluation: Monash Watch is actively monitoring 272 of 376 intervention patients, with 195 controls over 22 months (ongoing). Trajectories of poor health (SRH) and anticipation of worse/uncertain health (AH), and CG concerns statistically shifted at a tipping point, 3 days before admission in the subset who experienced ≥1 acute admission. The −3 day point was generally consistent across age and gender. Three randomly selected case studies demonstrate the processes of anticipatory and reactive care. PaJR-supported services achieved higher than pre-set targets—consistent reduction in acute bed days (20–25%) vs. target 10% and high levels of patient satisfaction.Discussion: Anticipatory care is an emerging trajectory data analytic approach that uses human sense-making as its core metric demonstrates improvements in processes and outcomes. Multiple sources can provide big data to inform trajectory care, however simple tailored data collections may prove effective if they embrace human interoception and anticipation. Admission risk may be addressed with a simple data collections including SRH, AH, and CG perceptions, where practical.Conclusion: Anticipatory care, as operationalized through PaJR approaches applied in MonashWatch, demonstrates processes and outcomes that successfully ameliorate PPH.

Disparities in Potentially Preventable Hospitalizations: Near-National Estimates for Hispanics.

To obtain near-national rates of potentially preventable hospitalization (PPH)-a marker of barriers to outpatient care access-for Hispanics; to examine their differences from other race-ethnic groups and by Hispanic national origin; and to identify key mediating factors. Data from all-payer inpatient discharge databases for 15 states accounting for 85 percent of Hispanics nationally. Combining counts of inpatient discharges with census population for adults aged 18 and older, we estimated age-sex-adjusted PPH rates. We examined county-level variation in race-ethnic disparities in these rates to identify the mediating role of area-level indicators of chronic condition prevalence, socioeconomic status (SES), health care access, acculturation, and provider availability. Age-sex-adjusted PPH rates were 13 percent higher among Hispanics (1,375 per 100,000 adults) and 111 percent higher among blacks (2,578) compared to whites (1,221). Among Hispanics, these rates were relatively higher in areas with predominantly Puerto Rican and Cuban Americans than in areas with Hispanics of other nationalities. Small area variation in chronic condition prevalence and SES fully accounted for the higher rates among Hispanics, but only partially among blacks. Hispanics and blacks face higher barriers to outpatient care access; the higher barriers among Hispanics (but not blacks) seem mediated by SES, lack of insurance, cost barriers, and limited provider availability.