Preventable Hospitalization Rates Research Articles

Geographic Variation in Preventable Hospitalization of Older Women and Men: Implications for Access to Primary Health Care

ABSTRACT This study demonstrates how readily available data and small area analysis can be used to identify potential problems of access to primary care services for older women and men. Gender and socio-economic differences in rates of preventable hospitalization are examined. Using hospital discharge data, five county and twenty-four intra-county areas in Upstate New York are studied. There is significant variation in preventable hospitalization within counties. Areas having significantly higher rates of these hospitalizations tend to have higher rates for both women and men. Problems of access are associated with lower income areas for women and men.

Assessment of Quality of Care for Managed Care and Fee-For-Service Patients Based on Analysis of Avoidable Hospitalizations

As managed care has grown to dominate the US health care delivery system, questions have been raised about the impact on the quality of care provided to its enrollees. Two important aspects of health care quality are access to care and the appropriateness of care. This analysis evaluated the occurrence of preventable hospitalizations among managed care (MCO) versus fee for service (FFS) populations to compare access to and appropriateness of preventive, primary, and surgical health care services. Rates of preventable hospitalizations associated with ambulatory sensitive conditions (ASCs) were calculated based on all discharges from Massachusetts hospitals in 1995, and categorized by population characteristics including: age, sex, ethnicity, and insurance status. Multivariate logistic regression models were employed to explain the likelihood of having a preventable hospitalization. Rates of preventable hospitalizations for two of the conditions evaluated (perforated appendix and diabetes complications) were lower for MCO enrollees. For two additional indicators (immunization preventable pneumonia and low birth weight), MCO rates were no different from FFS rates. Results for pediatric asthma were inconclusive. For four out of five quality indicators evaluated, individuals in Massachusetts MCOs are doing better or no worse than their counterparts in FFS plans. Until population-based data on managed care enrollees becomes available, and until such data can be linked to utilization and health outcomes information, investigations into the quality of services provided by MCOs compared to FFS plans cannot be definitive.

Preventable hospitalization and avoidable maternity outcomes: implications for access to health services for Medicaid recipients.

This study demonstrates how readily available hospital discharge data and small area methods can be used to identify potential problems of access to primary and prenatal outpatient health services for Medicaid populations. We examine whether rates of preventable hospitalization and avoidable maternity outcomes differ across geographic areas by their concentration of Medicaid recipients. Five county and twenty-four intra-county areas in Upstate New York are examined. Individuals living in Medicaid intra-county areas had significantly higher rates of these hospitalizations than persons living in non-Medicaid areas. Public health managers can use these methods to identify and compare areas in which access problems exist and to target and evaluate programs designed to improve access.

Access to Health Care and Preventable Hospitalizations-Reply

In Reply. —Dr Baker points out that, while highly significant, access to care does not explain all of the variation in preventable hospitalization rates. As for his suggestion that our propensity to seek health care measures might have predicted more of the variation in preventable hospitalization rates had we used less serious symptoms, we did not find that to be the case. In addition to the serious conditions we reported on, we also asked respondents about the importance of seeing a physician for five minor conditions (nasal congestion, upset stomach, cough without fever, stomach flu, and sprained ankle). Respondents' ratings of the importance of seeing a physician for these minor symptoms also did not explain variation in preventable hospitalization rates. Perhaps if we had measured symptoms that are more specifically linked to the study conditions, we would have found a stronger association between the propensity to seek health care and

Preventable Hospitalizations and Access to Health Care

To examine whether the higher hospital admission rates for chronic medical conditions such as asthma, hypertension, congestive heart failure, chronic obstructive pulmonary disease, and diabetes in low-income communities resulted from community differences in access to care, prevalence of the diseases, propensity to seek care, or physician admitting style. Analysis of California hospital discharge data. We calculated the hospitalization rates for these five chronic conditions for the 250 ZIP code clusters that define urban California. We performed a random-digit telephone survey among adults residing in a random sample of 41 of these urban ZIP code clusters stratified by admission rates and a mailed survey of generalist and emergency physicians who practiced in the same 41 areas. Community based. A total of 6674 English- and Spanish-speaking adults aged 18 through 64 years residing in the 41 areas were asked about their access to care, their chronic medical conditions, and their propensity to seek health care. Physician admitting style was measured with written clinical vignettes among 723 generalist and emergency physicians practicing in the same communities. We compared respondents' reports of access to medical care in an area with the area's cumulative admission rate for these five chronic conditions. We then tested whether access to medical care remained independently associated with preventable hospitalization rates after controlling for the prevalence of the conditions, health care seeking, and physician practice style. Access to care was inversely associated with the hospitalization rates for the five chronic medical conditions (R2 = 0.50; P < .001). In a multivariate analysis that included a measure of access, the prevalence of conditions, health care seeking, and physician practice style to predict cumulative hospitalization rates for chronic medical conditions, both self-rated access to care (P < .002) and the prevalence of the conditions (P < .03) remained independent predictors. Communities where people perceive poor access to medical care have higher rates of hospitalization for chronic diseases. Improving access to care is more likely than changing patients' propensity to seek health care or eliminating variation in physician practice style to reduce hospitalization rates for chronic conditions.