Factors that Influence Hospitalization for Chronic Medical Conditions

1. Factors that Influence Hospitalization for Chronic Medical Conditions Presented at: the AcademyHealth 2004 Annual Research Meeting, San Diego, CA, June 6–8, 2004 Panel Chair: Nancy McCall, Sc.D. P.O. Box 12194 · 3040 Cornwallis Road · Research Triangle Park, NC 27709Phone: 202-728-1968 · Fax: 202-728-2095 · nmccall@rti.org · www.rti.org RTI International is a trade name of Research Triangle Institute.

2. “Diagnoses for which timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease condition.” Billings (1993)

3. Motivation for Research • Kozak and colleagues showed significant increases in ACSC hospitalization rates for persons age 65 and older for CHF, pneumonia, and cellulitis using NHDS • CMS staff showed significant increases in hospitalization rates for sepsis, urinary tract infection, chronic bronchitis and dehydration

4. Motivation for Research • Majority of prior research has focused on cross-sectional analyses of ACSC hospitalization rates and found factors such as age, race, Medicaid status, and health status related to cross-sectional variation • NHDS does not allow for person-specific factors to be incorporated into analyses • Our research examined the influence of person-specific factors on observed ACSC hospitalization rates.

5. Panel Objectives • Explore factors that influence ACSC admissions in the Medicare Fee-for-Service (FFS) elderly population • Array of Data Sources • Medicare claims and enrollment data • MCBS data • CAHPS FFS survey data • Market-level supply and demand data • Array of analytic methods

6. Research on ACSC Hospitalizations • Critical examination of increasing rates of admission for 11 selected medical conditions in MFFS • Explored descriptively trends in rates of admission and ER/observation bed usage from 1992 – 2000 • Conducted 3 sets of multivariate analyses focusing upon a set of chronic conditions • Conducted an analysis of the relationship between ACSC hospitalization and beneficiary experience and satisfaction with care

7. Policy Importance • Inform effective Medicare policy aimed at changing the trajectory of ACSC hospitalization rates • CMS is contemplating the use of ACSC hospitalization rates as a performance measurement tool in Medicare managed care

8. Panel Session • “Are Changing Rates of Admission for Chronic Medical Conditions Simply a Reflection of Changes in the Demographics, Health Status, and Geographic Migration Patterns of the Elderly?” • “Does access to usual source of care and supplemental insurance prevent hospitalization for chronic medical conditions among the elderly?” • “Spatial Analysis of Healthcare Markets: Separating the Signal from the Noise in Ambulatory Care Sensitive Condition Admission Rates” • “Is There A Relationship between Hospital Encounters for Ambulatory Care Sensitive Conditions and Beneficiaries’ Experience and Satisfaction with Health Care?”