Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010-2012.

Gounder PP1, Seeman SM2, Holman RC1, Rarig A3, McEwen MK3, Steiner CA4, Bartholomew ML5, Hennessy TW1.

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Abstract

OBJECTIVE:

The U.S. Agency for Healthcare Research and Quality's Prevention Quality Indicators comprise acute and chronic conditions for which hospitalization can be potentially prevented by high-quality ambulatory care. The Healthy Alaska 2020 initiative (HA2020) targeted reducing potentially preventable hospitalizations (PPH) for acute and chronic conditions among its health indicators. We estimated the PPH rate for adults aged ≥ 18 years in Alaska during 2010-2012.

METHODS:

We conducted a cross-sectional analysis of state-wide hospital discharge data obtained from the Healthcare Cost and Utilization Project and the Indian Health Service. We calculated average annual PPH rates/1000 persons for acute/chronic conditions. Age-adjusted rate ratios (aRRs) were used for evaluating PPH rate disparities between Alaska Native (AN) and non-AN adults.

RESULTS:

Among 127,371 total hospitalizations, 4911 and 6721 were for acute and chronic PPH conditions, respectively. The overall crude PPH rate was 7.3 (3.1 for acute and 4.2 for chronic conditions). AN adults had a higher rate than non-AN adults for acute (aRR: 4.7; p < 0.001) and chronic (aRR: 2.6; p < 0.001) PPH conditions. Adults aged ≥ 85 years had the highest PPH rate for acute (43.5) and chronic (31.6) conditions. Acute conditions with the highest PPH rate were bacterial pneumonia (1.8) and urinary tract infections (0.8). Chronic conditions with the highest PPH rate were chronic obstructive pulmonary disease (COPD; 1.6) and congestive heart failure (CHF; 1.3).

CONCLUSION:

Efforts to reduce PPHs caused by COPD, CHF, and bacterial pneumonia, especially among AN people and older adults, should yield the greatest benefit in achieving the HA2020 goal.

KEYWORDS:

AHRQ, Agency for Healthcare Research and Quality; AI/AN, American Indian/Alaska Native; AN, Alaska Native; CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; HA2020, Healthy Alaskans 2020; HDDS, Hospital Discharge Data Set; Health services research; Healthcare disparities; IHS, Indian Health Service; NPIRS, National Patient Information Reporting System; Native American; PQIs, Prevention Quality Indicators; Quality of health care; RR, age-specific rate ratio; SE, standard error; SID, State Inpatient Database; UTI, urinary tract infection; aRR, age-adjusted rate ratio