AHRQ's Prevention Quality Indicators Help Connecticut Assess Preventable Hospitalizations
The Connecticut Office of Health Care Access (OHCA) used AHRQ's Prevention Quality Indicators (PQIs) for its databook, Preventing Hospitalizations in Connecticut: Assessing Access to Community Services, FYs 2000-2004. The databook, issued in September 2005, uses all 16 of AHRQ's PQIs to assess the quality of the health care system outside the hospital setting.
Comparing state acute care hospital discharge data to national data provided by AHRQ, OHCA found that Connecticut had a better record of preventable hospitalizations for 15 of the 16 PQIs. The PQIs were also used to examine disparities in hospitalizations of ambulatory care sensitive conditions (ACSC) by age and race and different rates of ACSC discharges by hospital and residential location.
Marybeth Bonadies, Director of Research and Planning at OHCA, notes that the availability of AHRQ's PQI data and methodology was an important factor in encouraging the office to produce the databook. "This will be a valuable resource for a variety of purposes, including helping guide our certificate of need process, assessing the factors contributing to hospitals' uncompensated care, and shaping policy for the state's Medicaid managed care initiative," she says.
Of particular significance is the databook's conclusion that preventable hospitalizations are increasing in the state, underscoring the need for timely intervention. Among the report's other significant findings were the following:
- In FY 2004, there were over 50,000 discharges of Connecticut residents with an ACSC, with nearly 300,000 total patient days and associated total charges of almost $900 million.
- ACSC hospitalizations accounted for 13 percent of all inpatient discharges and total hospital charges, and 15 percent of total patient days.
- From FYs 2000-2004, the number of ACSC discharges grew by 7 percent, patient days increased by 4 percent, and their associated total charges rose by 46 percent.
- ACSC patients tended to require extensive health care resources: nearly two-thirds were previously hospitalized, most were admitted through emergency departments (80 percent), and nearly half required additional care after discharge (25 percent transferred to other facilities and 20 percent to home health services).
The databook notes: "Hospitalizations... are considered 'preventable' because timely and effective primary care and medical management have been clinically demonstrated to significantly reduce the need for hospitalization for these widespread health conditions."
The preventable hospitalization databook is a screening tool identifying unmet health care needs and possible gaps in the health care system, on both state and local levels. In response to the Preventable Hospitalizations databook's publication, numerous local health care providers and health authorities have asked for ACSC information for their communities.
Hospitals, community health centers, and local departments of public health are using this information to design community outreach services, particularly those for the care and management of chronic illnesses such as diabetes and asthma. Local providers are also incorporating data into grant applications for disease management programs, chronic illness awareness education, and increased specialist care at community health centers.
OHCA has provided insurance carriers with additional preventable hospitalization information needed to analyze the effectiveness of disease management programs as cost-containment strategies. The agency has also presented this data to the state's Medicaid Managed Care Council.
OHCA intends to update and revise the databook periodically. It also hopes to make regional comparisons of PQIs, once other states publish similar studies.