Chartbook on Rural Health Care

Potentially Avoidable Hospitalizations

Potentially avoidable hospitalizations for all conditions per 100,000 population, by residence location, 2005-2012

2010 Achievable Benchmark: 938.6 per 100,000 Population.

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, 2005-2011 Nationwide Inpatient Sample and 2012 State Inpatient Databases quality analysis file and AHRQ Quality Indicators, version 4.4.

• Importance: 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).
• Overall Rate: In 2012, the overall rate of potentially avoidable hospitalizations for all conditions was 1,582 per 100,000 population.
• Change Over Time:
  • From 2005 through 2012, the overall rate of potentially avoidable hospitalizations for all conditions improved from 1,941 per 100,000 population to 1,582 per 100,000 population.
  • The rate of potentially avoidable hospitalizations for all conditions improved for all residence locations except small metropolitan: large central metropolitan, large fringe metropolitan, medium metropolitan, micropolitan, and noncore areas.
  • The disparity between residents living in micropolitan and large fringe metropolitan areas narrowed.
• Groups With Disparities:
  • From 2005 to 2012, the rate of potentially avoidable hospitalizations for all conditions was higher for people living in noncore areas compared with those living in large fringe metropolitan areas.
  • In 5 of 8 years, the rate of potentially avoidable hospitalizations for all conditions was higher for people living in micropolitan areas compared with those living in large fringe metropolitan areas.
  • In 2012, the rate of potentially avoidable hospitalizations for all conditions for people living in noncore (1,979 per 100,000) and micropolitan (1,707 per 100,000) areas was higher than for residents living in large fringe metropolitan areas (1,427 per 100,000).
• Achievable Benchmark:
  • The 2010 top 4 State achievable benchmark was 938.6. The top 4 States that contributed to the achievable benchmark are Hawaii, Oregon, Utah, and Washington.
  • At current rates of improvement, it would take 13 years for the total population to reach the achievable benchmark.
  • The benchmark for residents of micropolitan, large central metropolitan, large fringe metropolitan, medium metropolitan, and noncore areas could be achieved in 9, 10, 14, 15, and 16 years, respectively. Residents of small metropolitan areas are not making progress toward the benchmark.

Potentially Avoidable Hospitalizations

Potentially avoidable hospitalizations for all conditions per 100,000 population, by residence location, stratified by race/ethnicity, 2012

Key: API = Asian or Pacific Islander.
Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, 2012 State Inpatient Databases disparities analysis file and AHRQ Quality Indicators, version 4.4.
Note: White, Black, and API are non-Hispanic. Hispanic includes all races. Data for micropolitan areas for APIs and small metropolitan areas for Hispanics did not meet criteria for statistical reliability.

• Overall Rate: In 2012, the rate of potentially avoidable hospitalizations for all conditions per 100,000 population was 1,529 for large central metropolitan, 1,524 for large fringe metropolitan, 1,340 for medium metropolitan, 1,509 for small metropolitan, 1,653 for micropolitan, and 1,847 for noncore areas.
• Groups With Disparities:
  • In 2012, the rate of potentially avoidable hospitalizations for all conditions was higher for Whites living in noncore areas (1,813 per 100,000 population) compared with those living in large fringe metropolitan areas (1,436 per 100,000 population).
  • In 2012, the rate of potentially avoidable hospitalizations for all conditions was higher for Asians and Pacific Islanders (APIs) living in noncore areas (938 per 100,000 population) compared with those living in large fringe metropolitan areas (559 per 100,000 population).

Admissions for Influenza

Admissions for immunization-preventable influenza per 100,000 population, age 65 and over, by residence location, 2000-2012

2011 Achievable Benchmark: 26.3 per 100,000 Population.

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, 2000-2011 Nationwide Inpatient Sample and 2012 State Inpatient Databases quality analysis file and AHRQ Quality Indicators, version 4.4.

• Importance: Immunization is a cost-effective strategy for reducing illness, death, and disparities associated with influenza.
• Overall Rate: In 2012, the rate of admissions for immunization-preventable influenza in patients age 65 and over was 54 per 100,000 population.
• Change Over Time: From 2000 to 2012, there was no clear geographic pattern in the rate of admissions for immunization-preventable influenza among people age 65 and over.
• Groups With Disparities: In 11 of 13 years, admissions for immunization-preventable influenza per 100,000 population age 65 and over was higher for people living in noncore areas compared with those living in large fringe metropolitan areas.
• Achievable Benchmark:
  • The 2011 top 4 State achievable benchmark was 26.3 per 100,000 population. The top 4 States that contributed to the achievable benchmark are Hawaii, Nevada, New Jersey, and Oregon.
  • The total population and residents of large central metropolitan and small metropolitan areas are moving away from the benchmark. Residents of large fringe metropolitan areas are not making progress toward the benchmark.
  • Residents of micropolitan, noncore, and medium metropolitan areas could not achieve the benchmark for more than 20 years.

Emergency Department Visits

All emergency department visits per 100,000 population, adults age 18 and over, by residence location, 2008-2011

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, 2008-2011 Nationwide Emergency Department Sample and AHRQ Quality Indicators, version 4.4.

• Importance: Emergency department (ED) visits are costly. Because some visits are potentially avoidable, they may be indicative of poor care management, inadequate access to care, or poor choices on the part of beneficiaries (Dowd, et al., 2014). ED visits for conditions that are preventable or treatable with appropriate primary care lower health system efficiency and raise costs (Enard & Ganelin, 2013). An estimated 13% to 27% of ED visits in the United States could be managed in physician offices, clinics, and urgent care centers, saving $4.4 billion annually (Weinick, et al., 2010).
• Overall Rate: In 2011, the rate of all ED visits was 3,865 per 100,000 population.
• Change Over Time: There were no statistically significant changes over time in the rate of ED visits overall or by residence location.
• Groups With Disparities: In 2011, the rate of ED visits per 100,000 population was higher for residents of noncore areas (4,853) and micropolitan areas (4,579) compared with residents of large fringe metropolitan areas (3,430).

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