Chartbook on Care Coordination

• Hospitalizations due to ambulatory care-sensitive conditions (ACSCs) such as hypertension and pneumonia should be largely prevented if ambulatory care is provided in a timely and effective manner.
• Evidence suggests that effective primary care is associated with lower ACSC hospitalization (also referred to as avoidable hospitalization) (Gao, et al., 2014).

Potentially Avoidable Hospitalization Measures

• Measures of potentially avoidable hospitalization include:
  • Potentially avoidable hospitalizations for acute and chronic conditions.
  • Admissions with perforated appendix.
  • Admissions with hypertension.

Potentially Avoidable Hospitalizations

Potentially avoidable hospitalizations, by type of condition, 2005-2012, and by race/ethnicity, stratified by income, 2012

Left Chart:

Right Chart (All Conditions):

Key: API = Asian or Pacific Islander; Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.4, 2005-2012.
Note: White, Black, and API are non-Hispanic. Hispanic includes all race.

• From 2005 to 2012, the rate of potentially avoidable hospitalizations for all conditions fell from 1,941.2 to 1,582.4 per 100,000 population, the rate for acute conditions decreased from 822.9 to 621.5 per 100,000 population, and the rate for chronic conditions fell from 1,118.4 to 960.0 per 100,000 population.
• In 2012, in all income groups, rates of potentially avoidable hospitalizations for all conditions were higher for Blacks than Whites and lower for Asians and Pacific Islanders (APIs) than Whites.
• In all years, residents of noncore areas had significantly higher rates of potentially avoidable hospitalizations than residents of large fringe metropolitan areas for all conditions and acute conditions; for chronic conditions, it was 6 of 8 years. Residents of micropolitan areas had significantly higher rates of potentially avoidable hospitalizations than residents of large fringe metropolitan areas for all conditions in 5 of 8 years and for acute conditions in 6 of 8 years (data not shown).
• In 2011, the top 4 State achievable benchmark for all potentially avoidable hospitalizations was 939 per 100,000 population. The overall achievable benchmark could not be attained for 13 years. Hispanics in the highest income quartile and APIs in all income groups have already achieved the benchmark.
• The top 4 State achievable benchmark for acute potentially avoidable hospitalizations was 402 per 100,000 population. The acute achievable benchmark could not be attained for 8 years.
• The top 4 State achievable benchmark for chronic potentially avoidable hospitalizations was 532 per 100,000 population. The chronic achievable benchmark could not be attained for 25 years.

Admissions With Perforated Appendix

Admissions with perforated appendix in community hospitals and Indian Health Service, Tribal, and contract hospitals, by age, 2003-2012

Left Chart (Community Hospitals):

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.4, 2003-2012.

Right Chart (Indian Health Service, Tribal, and contract hospitals):

Source: Indian Health Service, Office of Information Technology/National Patient Information Reporting System, National Data Warehouse, Workload and Population Data Mart, 2003-2012.

• From 2003 to 2012, the rate of perforated appendixes was higher for those ages 45-64 and those age 65 and over than for those ages 18-44.
• In 2012, for Indian Health Service (IHS) facilities, the rates of perforated appendixes for ages 45-64 and age 65 and over were higher than for those ages 18-44 (436.1 and 538.5 per 1,000 admissions, respectively, compared with 302.2 per 1,000 admissions.
• In all years, rates of perforated appendixes for males were higher than for females at non-IHS hospitals; rates were higher for males than for females in 9 of 10 years at IHS hospitals (data not shown).

Avoidable Admissions With Hypertension

Avoidable admissions with hypertension, by region, 2005-2012, and race/ethnicity, stratified by income, 2012

Left Chart:

Right Chart:

Key: API = Asian or Pacific Islander; Q = quartile.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, Nationwide Inpatient Sample and AHRQ Quality Indicators, version 4.4, 2005-2012.
Note: White, Black, and API are non-Hispanic. Hispanic includes all race.

• From 2005 to 2012, the rates of avoidable admission for hypertension increased from 48.4 to 60.0 per 100,000 population.
• In 2012, rates of avoidable admission for hypertension were 74.3 per 100,000 population in the South, 63.1 per 100,000 population in the Northeast, 53.7 per 100,000 population in the Midwest, and 39.9 per 100,000 population in the West.
• Overall in 2012, rates of avoidable admission for hypertension were higher for Blacks and Hispanics than for Whites (199.6 and 67.2 per 100,000 population, respectively). Rates were lower for API s compared with Whites (28.5 vs. 39.1 per 100,000 population).
• In 2012, in all income groups , rates of avoidable admission for hypertension were higher for Blacks than Whites. In the first, second, and third income quartiles, Hispanics had higher rates than Whites. In the fourth income quartile, APIs had a lower rate than Whites.
• From 2005 to 2012, the rate of admissions with hypertension got worse for residents of large fringe metropolitan, medium metropolitan, and small metropolitan areas (data not shown).

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