This Fact Book examines one critical area of health care quality: potentially preventable hospitalizations, or hospitalizations that may be preventable with high quality primary and preventive care. These hospitalizations may be avoided if clinicians effectively diagnose, treat, and educate patients, and if patients actively participate in their care and adopt healthy lifestyle behaviors. Thus, higher rates of "preventable hospitalizations" may pinpoint areas in which potential improvements can be made in the quality of the U.S. health care system.
This report presents information on preventable hospitalizations for select chronic and acute conditions, as well as for one birth outcome. The Fact Book first addresses these conditions in a broad, national-level context. It evaluates time trends between 1994 and 2000; variations across regions of the United States; and hospitalizations among priority populations, including children, older Americans, women, low-income, and rural residents. The report then provides detailed statistics for each health condition.
Results are based on the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database and the Agency for Healthcare Research and Quality's (AHRQ) Prevention Quality Indicators (PQIs). All statistics presented in this report are adjusted for the age and sex distribution of the population.
Decisionmakers at national, State, and local levels may use this Fact Book to establish national benchmarks and to identify target areas for quality improvement. For example, a community or State could apply the PQIs to hospital discharge data to identify regions with high numbers of preventable admissions for particular conditions.
Between 1994 and 2000, rates of preventable hospitalizations improved for certain health conditions. The most striking improvements were:
In contrast, admission rates rose among other conditions as follows:
Variations in hospitalization rates exist across the 4 U.S. Census regions: Northeast, South, West, and Midwest. Admissions for preventable hospitalizations are most encouraging in the West, where rates are the lowest in the Nation for 15 of the 16 PQIs. The Northeast has the lowest rate of hospitalizations for perforated appendix.
Conversely, the South has the highest rates of hospitalization for most indicators, including:
Populations most vulnerable to illness, such as older Americans and very young children, experience the highest rates of preventable admission.
Older Americans are more likely than any other age group to be hospitalized for:
Compared with children 5-17 years of age, young children under the age of 5 experience significantly higher rates of preventable hospitalization. The differences are most striking for:
Also, young children under the age of 5 are much more likely to be hospitalized for pediatric asthma, the most common chronic disease among children.
These results indicate that specific age groups are more susceptible than others to certain conditions. Conditions such as congestive heart failure and chronic obstructive pulmonary disease are particularly relevant to older adults. Therefore, it may be appropriate to apply these prevention quality indicators to those who are 65 years of age and older. In contrast, PQIs for pediatric gastroenteritis, pediatric asthma, and dehydration are particularly useful for children, and can be used to examine the substantially higher risks observed for those who are 0-4 years of age.
The greatest difference occurs for treatment of adult asthma; for this condition, women are more than 2.5 times more likely than men to be admitted to the hospital. A contrast emerges for younger populations: girls are approximately 30 percent less likely than boys to be hospitalized for pediatric asthma.
Women also have higher rates of admission for:
On the other hand, women are less likely to be hospitalized for:
Residents from areas with the lowest median incomes (less than $25,000) have the highest rates of admission for all preventable hospitalizations. The greatest amount of variation occurs for:
Disparities based on community incomes are more pronounced for chronic conditions than for acute conditions. Among the 10 chronic conditions, differences in admission rates between the lowest and highest income communities range from 76 to 278 percent. In contrast, for the 5 acute conditions, differences in admission rates range from 6 to 78 percent.
In many cases, preventable admission rates are comparable for urban and rural residents. However, rural residents experience higher hospitalization rates for several conditions, including:
Table 1 summarizes the patterns of avoidable hospitalizations by types of conditions. The tables identify whether admission rates increased, decreased, or remained unchanged between 1994 and 2000, and also indicate the U.S. regions with the highest and lowest rates of hospitalization. In addition, the summary compares hospitalization rates for the following priority and reference populations: