Definition

The rate of "Potentially preventable hospitalizations" (i.e., hospitalizations that could have been prevented with high quality primary and preventative care) includes selected acute conditions that meet the inclusion and exclusion rules for the numerator in any of the Prevention Quality Indicators (PQIs). Expressed as a rate per 1,000.

Numerator

Number of preventable hospitalizations as defined by the Agency for Healthcare Research and Quality (AHRQ) for Prevention Quality Indicators (PQI) for adults (18+).

Denominator

Mid-year resident population of adult (18+) for the same calendar year.

Data Interpretation Issues

"Potentially preventable hospitalizations" include selected acute conditions that meet the inclusion and exclusion rules for the numerator in any of the following Prevention Quality Indicators (PQIs): PQI #10 Dehydration Admission Rate; PQI #11 Bacterial Pneumonia Admission Rate; PQI #12 Urinary Tract Infection Admission Rate, and selected chronic conditions that meet the inclusion and exclusion rules for the numerator in any of the following PQIs: PQI #1 Diabetes Short-Term Complications Admission Rate; PQI #3 Diabetes Long-Term Complications Admission Rate; PQI #5 Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults Admission Rate; PQI #7 Hypertension Admission Rate; PQI #8 Heart Failure Admission Rate; PQI #13 Angina Without Procedure Admission Rate; PQI #14 Uncontrolled Diabetes Admission Rate; PQI #15 Asthma in Younger Adults Admission Rate; PQI #16 Lower-Extremity Amputation among Patients with Diabetes Rate. Discharges that meet the inclusion and exclusion rules for the numerator in more than one of the above PQIs are counted only once in the composite numerator. For more information on Hospital Discharge Data, see [http://dhss.alaska.gov/dph/HealthPlanning/Pages/hospitaldischarge.aspx].

Why Is This Important?

Access to quality healthcare is influenced by a number of factors, including: having a usual source of care, having health insurance, and being able to afford care. Preventable hospitalizations are a set of conditions for which hospitalization could be avoided if patients had early access to good quality outpatient healthcare; this metric can be used to assess the effectiveness and accessibility of primary healthcare. A study using the National Hospital Discharge Survey found that 12% of all hospitalizations in 1990 (3.1 million) were for potentially preventable conditions.^1^[[br]] [[br]] {{class .SmallerFont 1. Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997 May; 87(5): 811-816. }}

Other Objectives

Healthy Alaskans 2020 Indicator 22: Reduce the rate of preventable hospitalizations (hospitalizations that could have been prevented with high quality primary and preventive care) based on the Agency for Healthcare Research and Quality definition to 6.7 per 1,000 by 2020.

Evidence-based Practices

As part of the Healthy Alaskans 2020 health improvement process, Alaskan subject matter experts identified the following strategies to prevent unnecessary hospitalizations. '''Strategy 1:''' Increase access to high quality primary care. '''Evidence Base:''' Patients who receive prompt attention from primary care providers for acute illness or worsening chronic conditions have a greater opportunity to avoid hospitalization. While hospitalization cannot always be prevented, even with access to the highest quality primary care, evidence demonstrates that communities with poorer access to coordinated primary care tend to have higher rates of potentially preventable hospitalizations. Studies by the Agency for Healthcare Research and Quality (AHRQ) and others, supported by the National Institutes of Health, demonstrate a positive correlation between use of high quality primary care services and reductions in hospital utilization. '''Sources:''' [[br]] Moy E, Barrett M, Ho K. Potentially Preventable Hospitalizations - United States, 2004-2007. MMWR. 2011; 60(1): 80-83. [[br]] Kronman AC, Ash AS, Freund KM, et al. Can primary care visits reduce hospital utilization among Medicare beneficiaries at the end of life? J Gen Intern Med. 2008; 23(9): 1330-1305. [[br]] [http://www.guideline.gov National Guideline Clearinghouse] [[br]] [http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx Prevention Quality Indicators Overview] '''Strategy 2:''' Improve care coordination, community care transitions, and complex case management. '''Evidence Base:''' Preventable hospital admissions and readmissions are indicators of health system fragmentation. Care management programs that improve care coordination and transitions between different levels of care, and complex case management programs that manage and coordinate care for patients with multiple or complex health needs, have demonstrated positive results in reducing hospitalization of high risk patients. Studies by federal agencies, insurers, and researchers have demonstrated the importance of effective care models in preventing hospital admissions. '''Sources:''' [http://www.guidline.gov National Guideline Clearinghouse] [[br]] [http://www.qualityindicators.ahrq.gov/modules/pqi_resources.aspx Prevention Quality Indicators Overview] [[br]] McDonald KM, Sundaram V, Bravata DM, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies. Volume 7 - Care Coordination. Rockville, MD: Agency for Healthcare Research and Quality. 2007. [[br]] Bayer, E. Innovations in reducing preventable hospital admissions, readmissions, and emergency room use: an update on health plan initiatives to address national health care priorities. Washington, DC: AHIP Center for Policy and Research. 2010. [[br]] Brown RS, Peikes D, Peterson G, et al. Six Features of Medicare Coordinated Care Demonstration Programs that Cut Hospital Admissions of High-Risk Patients. Health Aff. 2012; 31(6): 1156-1166. '''Strategy 3*:''' Strengthen community-based and clinical prevention to improve population health. '''Evidence Base:''' Community-based prevention programs employing evidence-based public health strategies aimed at protecting and maintaining the health of populations are cost effective methods of preventing disease, injury and disability, and reducing utilization of health care services including hospitalization. Clinical preventive services, such as vaccination, have been demonstrated to provide a very high return on investment in terms of health care costs, disease burden, and death. * Sources for Strategy 3 can be found at: [http://hss.state.ak.us/ha2020/assets/EBS/HA2020_EBS22_PreventableHospitalizations.pdf] A listing of strategies, actions, and key partners on this measure can be found at: [http://hss.state.ak.us/ha2020/assets/Actions-Partners_22_PreventableHosp.pdf].

Data Notes

** Data Not Available

Data Source

Health Planning and Systems Development, Division of Public Health, Alaska Department of Health and Social Services

References and Community Resources

'''References:''' 1. Pappas G, Hadden WC, Kozak LJ, Fisher GF. Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997 May; 87(5): 811-816.