NHQR Efficiency Measurement: Potentially Avoidable Hospitalization Trends & Costs

1. NHQR Efficiency Measurement: Potentially Avoidable Hospitalization Trends & Costs Roxanne M. Andrews, Ph.D. Agency for Healthcare Research and Quality Center for Delivery, Organization, and Markets September 14, 2009

2. What are potentially avoidable hospitalizations? • Hospitalizations that may be preventable with high quality primary & preventive care • Commonly measured by examining hospitalizations for specific conditions— “ambulatory care sensitive conditions” • Example: Asthma • Patients may be hospitalized for asthma if they do not receive adequate outpatient care, or primary care practitioners do not adhere to practice guidelines or prescribe appropriate treatments. • As an efficiency measure, it is assumed that hospitalizations for these conditions are more costly than good quality outpatient care.

3. How are potentially avoidable hospitalizations measured in the NHQR? • AHRQ Prevention Quality Indicators (PQIs) • One module of the AHRQ Quality Indicators software • Set of measures to identify hospitalizations for "ambulatory care sensitive conditions" (ACSCs) in adult populations. • PQIs use existing hospital discharge data, based on readily available data elements • PQIs adjust for age and gender of the population • All the hospitalizations are not preventable, but these are areas where improvements in outpatient & preventive care could reduce U.S. hospital costs

4. Chronic Diabetes complications - short term Diabetes complications - long term Uncontrolled diabetes Lower extremity amputation COPD Hypertension Congestive heart failure Angina without procedure Adult asthma Acute Dehydration Bacterial pneumonia Urinary tract infection Prevention Quality Indicators (PQIs) Composite Measures 4

5. Data Source: Nationwide Inpatient Sample • Part of the Healthcare Cost and Utilization Project family of databases • Designed for national estimates related to U.S. hospitalizations • Uses all-payer hospital administrative (billing) data • Based on data supplied by state data organizations • A 20% stratified sample of U.S. hospitals (all discharges from the hospital)

6. Measures in the NHQR • Trends in PQI composite rates • Per 100,000 population • Trends in national costs for PQI composite • Adjust for inflation (gross domestic product implicit price deflator) • Deflate hospital charges to hospital costs using HCUP cost-to-charge ratios • Costs represent the hospitals’ cost of production • Not what was paid • Does not include physician costs billed separately

7. National trends in potentially avoidable hospitalization rates, by type of condition Note: Adults only. Rates are adjusted for age & gender. Source:Healthcare Cost and Utilization Project, Nationwide Inpatient Sample

8. Trends in national hospital costs of potentially avoidable hospitalizations Note: Adults only. Source: Healthcare Cost and Utilization Project, Nationwide Inpatient Sample

9. Comments • Previous literature indicates variations in preventable hospitalization rates by race, SES and geographic location • NHDR illustrates variations by race & SES in individual PQIs • NHQR State Snapshots illustrates variations by State in individual PQIs • AHRQ Preventable Hospitalization Costs mapping software can identify counties with high costs for PQI conditions

10. 2,500 2,000 Northeast 1,500 Midwest South Hospitalizations per 100,000 population 1,000 West 500 0 2000 2005 Regional variations in Overall PQI Composite rate Source:Healthcare Cost and Utilization Project, Nationwide Inpatient Sample

11. Comments • Examining the variations in potentially avoidable hospitalizations offer opportunities to identify communities and populations for targeted interventions • These interventions could lead to improvements in one dimension of efficiency