NHRQ Efficiency Measurement: Potentially Avoidable Hospitalization Trends & Costs

Slide 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

Slide 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.

Slide 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

Slide 4

Prevention Quality Indicators (PQIs) Composite Measures

• 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

Slide 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)

Slide 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

Slide 7

National trends in potentially avoidable hospitalization rates, by type of condition

An graph of the Hospitalizations per 100,000 population is shown.

Note: Adults only. Rates are adjusted for age & gender.
Source: Healthcare Cost and Utilization Project, Nationwide Inpatient Sample

Slide 8

Trends in national hospital costs of potentially avoidable hospitalizations

A graph of the Costs (in billions of 2005 $) is shown.

Note: Adults only.
Source: Healthcare Cost and Utilization Project, Nationwide Inpatient Sample

Slide 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

Slide 10

Regional variations in Overall PQI Composite rate

Slide 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