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Adult Potentially Preventable Hospitalizations in Texas

Adult Potentially Preventable Hospitalizations in Texas. 2014 Crossroads Conference: Navigating Health Care in West Texas June 5, 2014 Mike Gilliam, Jr., M.S.W., M.P.H. Assessment & Benchmarking Specialist Texas Department of State Health Services (DSHS).

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Adult Potentially Preventable Hospitalizations in Texas

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  1. Adult Potentially Preventable Hospitalizations in Texas 2014 Crossroads Conference:Navigating Health Care in West TexasJune 5, 2014 Mike Gilliam, Jr., M.S.W., M.P.H.Assessment & Benchmarking SpecialistTexas Department of State Health Services (DSHS)

  2. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) • Since 2008, DSHS has educated communities and policymakers on the impact of these ten adult potentially preventable hospitalization conditions: 1. Bacterial Pneumonia; 2. Dehydration; 3. Urinary Tract Infection (UTI); 4. Angina (without procedures); 5. Congestive Heart Failure (CHF); 6. Hypertension; 7. Asthma; 8. Chronic Obstructive Pulmonary Disease (COPD); 9. Diabetes Short-term (ST) Complications; and 10. Diabetes Long-term (LT) Complications. Adult hospitalizations for these conditions are considered “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.

  3. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012)

  4. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012)

  5. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) • Methodology to identify “Potentially Preventable Hospitalizations” was developed by the Agency for Healthcare Research and Quality (AHRQ). AHRQ is the lead federal agency responsible for research on healthcare quality costs, outcomes and patient safety. • Potentially Preventable Hospitalizations are also referred to as Ambulatory Sensitive Conditions, Prevention Quality Indicators and/or Potentially Preventable Admissions/Events. • Potentially Preventable Hospitalization data is based on primary diagnosis. • Potentially Preventable Hospitalization data is based on county of residence – not the county where the individual was hospitalized.

  6. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) • The purpose of this information is to assist in improving healthcare and reducing healthcare costs. • This information is not an evaluation of hospitals or other healthcare providers. • This information can be used as a tool to assess a community’s outpatient healthcare system. • Inpatient hospital data in Texas is available from the Texas Health Care Information Collection (www.dshs.state.tx.us/thcic), in the Center for Health Statistics, at DSHS.

  7. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) • *From 2007-2012, adult residents of Texas received approximately $47.4 Billion (B) in charges for 1,459,249 hospitalizations that were potentially preventable. • *$47.4 B equals $2,483 for every adult Texan. • *Allocation of the $47.4 B by Expected Primary Source of Payment: ...Medicare $30.0 B (63.3%) …Private Health Insurance $ 8.5 B (18.0%) …Uninsured $ 4.6 B (09.7%) …Medicaid $ 3.2 B (06.8%) …Other $ 1.1 B (02.2%) *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

  8. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) • *Number of Hospitalizations: 1,459,249 • *Average Hospital Charge: $32,464 • *Average Length of Hospital Stay: 4.9 Days • *Average Age of Individual Hospitalized: 63 Years *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

  9. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) *Values of less than 3% are included in “Other” Texas (U.S. Census 2010, Adult Population) White (Race): 72.2% Black (Race): 11.6% Other (Race): 16.2% Hispanic (Ethnicity): 33.6%

  10. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) *Values of less than 3% are included in “Other”

  11. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) *Values of less than 3% are included in “Other”

  12. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) B means Billion M means Million *Values of less than 3% are included in “Other”

  13. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) Combined, Bacterial Pneumonia and CHF comprise: • *43.3% (632,354) of admissions for Potentially Preventable Hospitalizations; and • *50.2% ($23.8 B) of charges for Potentially Preventable Hospitalizations. *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

  14. Adult Potentially Preventable Hospitalizationsin Texas Secondary Diagnosis of Mental Illness/Substance Abuse in Adult Potentially Preventable Hospitalizations in Texas (2006-2010) For example, 32.5% of the 250,721 adult potentially preventable hospitalizations for Bacterial Pneumonia (2006-2010) had a secondary diagnosis of mental illness/substance abuse. *Alcohol and other Drug Diagnoses (Excluding Tobacco Use Disorder) are Significantly Underrepresented Due to Data Suppression Requirements.

  15. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012)

  16. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) In-depth data profiles are available with the following information: • Years (2007-2012); • Condition (Ten Conditions); • County; • Age Group; • Sex; • Race; • Ethnicity; • Zip Code of Residence; • Hospitalized at; • Average Length of Hospital Stay; • Average Hospital Charge; • Total Hospital Charges; • Discharged to; and • Expected Primary Source of Payment. To request an in-depth profile, send an email to mike.gilliam@dshs.state.tx.us.

  17. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) Example of In-Depth Data Profile:

  18. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) Example of In-Depth Data Profile:

  19. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) Efforts to Reduce Adult Potentially Preventable HospitalizationsThe 82nd Texas Legislature appropriated $2 M for DSHS to implement the Reducing Adult Potentially Preventable Hospitalizations Initiative in FY 12/13. DSHS contracted with 16 counties to implement evidence-based interventions, through a community coordinated approach, to reduce hospitalizations and/or hospital charges among adult county residents for selected potentially preventable hospitalization conditions. Adult residents in each of the 16 counties had a hospitalization rate more than 50% higher than the state rate from 2005-2009. Each of the 16 counties had a Project Contact that coordinates monthly coalition meetings to maximize implementation of one or more of the following evidence-based interventions: immunizations; patient education; community education; smoking cessation; healthcare provider education; diabetes self-management education; patient case management; nutrition & physical activity; weight management; glycemic control; and blood pressure control.

  20. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012)

  21. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) FY12/13 Reducing Adult Potentially Preventable Hospitalizations Initiative (01/01/12 – 08/31/13)

  22. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) FY14/15 Reducing Adult Potentially Preventable Hospitalizations Initiative (09/01/13 – 08/31/15) DSHS re-contracted with 13 of the 16 counties funded in FY12/13.

  23. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) TRENDS: Adult Potentially Preventable Hospitalizations *18-39 Years of Age **40+ Years of Age Note: AHRQ recently released new methodology that separates Asthma Potentially Preventable Hospitalizations into two conditions: Asthma in *Younger Adults and COPD or Asthma in **Older Adults. The table above reflects this new methodology.

  24. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) TRENDS: Adult Potentially Preventable Hospitalizations Source: America’s Health Rankings – United Health Foundation • Comparing the 2013 Report to the 2010 Report, the discharge rate in Texas decreased 13.7%, as compared to the discharge rate in the U.S. which decreased 8.1%.

  25. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) TRENDS: Adult Potentially Preventable Hospitalizations Overall PQI Rate is an AHRQ aggregate calculation of all adult potentially preventable hospitalizations. • From 2008 to 2011, the overall PQI rate for adult residents of: • Freestone County decreased 27.2%; • Red River County decreased 26.4%; and • Texas decreased 15.0%. Under the leadership of the county judge in 2008, community health coalitions in Freestone and Red River County worked with DSHS to use the potentially preventable hospitalization data to attempt to reduce adult potentially preventable hospitalizations. For example, both counties implemented vaccine outreach campaigns targeting Bacterial Pneumonia.

  26. Adult Potentially Preventable Hospitalizationsin Texas (2007-2012) Project Website (www.dshs.state.tx.us/ph) • State Profile; • Profiles on all 254 counties in Texas; • Clinical Interventions; • Maps illustrating the impact of potentially preventable hospitalization conditions in Texas counties; and • Funded Counties (Reducing Adult Potentially Preventable Hospitalizations Initiative) . Contact Information: Mike Gilliam, Jr.(512)776-2708 mike.gilliam@dshs.state.tx.us

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