NHQR Efficiency Measurement: Potentially Avoidable Hospitalization Trends

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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

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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.

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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

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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

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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)

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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

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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
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Trends in national hospital costs of potentially
avoidable hospitalizations

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

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Regional variations in Overall PQI Composite rate
Source Healthcare Cost and Utilization Project,
Nationwide Inpatient Sample
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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