National Healthcare Disparities Report - LDI Health Economist

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Efficiency Figure 7.2. Potentially avoidable hospitalization rates, by race/ethnicity and area income, 2001-2008 4000 White Black API Hispanic 4000 First Quartile (Lowest Income) Second Quartile Third Quartile Fourth Quartile (Highest Income) Chapter 7 Rate per 100,000 Population 3000 2000 Rate per 100,000 Population 3000 2000 1000 2008 Achievable Benchmark: 818 1000 2008 Achievable Benchmark: 818 0 2001 2002 2003 2004 2005 2006 2007 2008 0 2001 2002 2003 2004 2005 2006 2007 2008 Key: API = Asian or Pacific Islander. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, State Inpatient Databases disparities analysis file, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2001-2008. Denominator: Civilian noninstitutionalized adults age 18 and over. Note: For this measure, lower rates are better. Annual rates are adjusted for age and gender. White, Black, and Asian or Pacific Islander populations are non-Hispanic. Income quartiles are based on median income of ZIP Code of patient’s residence. n From 2001 to 2008, the overall rate of avoidable hospitalizations fell from 1,657 to 1,433 per 100,000 population (data not shown). Declines in avoidable hospitalizations were observed among all raceial/ethnic and income groups (Figure 7.2). n In all years, rates of potentially avoidable hospitalizations were higher among Blacks compared with Whites and lower among Asians and Pacific Islanders (APIs) compared with Whites. Except in 2001 and 2008, rates were also higher among Hispanics compared with Whites. n In all years, rates of potentially avoidable hospitalizations were higher among residents of areas in the lowest and second income quartiles compared with residents of the highest income quartile. n In 2008, the top 3 State achievable benchmark for all potentially avoidable hospitalizations was 818 hospitalizations per 100,000. iii The overall achievable benchmark could not be attained for 20 years. n The only racial/ethnic group to attain the achievable benchmark as of 2008 was APIs, whereas Whites could not attain the benchmark for about 16 years. Blacks would not attain the benchmark for about 18 years, but Hispanics could attain the benchmark in 7 years. n High-income groups would attain the benchmark sooner than lower income groups (lowest quartile, about 41 years; second quartile, 15 years; third quartile, 14 years; and highest quartile, 9 years). iii The top 3 States that contributed to the achievable benchmark are Hawaii, Utah, and Washington. 194 National Healthcare Disparities Report, 2011
Efficiency Also, in the NHQR: n Declines in avoidable hospitalizations were observed for both acute and chronic conditions. NEW Excess Avoidable Hospitalizations The following analysis estimates numbers of excess preventable hospitalizations for 2008 by comparing adjusted rates of the AHRQ PQI composite with the benchmark rate. The benchmark rate was set by the States with rates in the top 10%. For excess preventable hospitalizations to be calculated, the difference between a group’s rate and the benchmark rate was multiplied by the number of people in the group (for example, for Hispanics, the difference between the Hispanic rate and the benchmark rate was multiplied by the number of Hispanics). Figure 7.3. Excess number of potentially preventable hospitalizations, by race/ethnicity, 2008 Chapter 7 2,500,000 Excess 2 Expected at Best Rate 2,000,000 Hospitalizations 1,500,000 1,000,000 63 78 74 500,000 0 White Black Hispanic Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, and AHRQ Quality Indicators, modified version 4.1, 2008. n In 2008, if Whites had the benchmark rate of preventable hospitalizations, they would have had almost 710,000 fewer hospitalizations (Figure 7.3). Instead of costing $15.2 billion, preventable hospitalization among Whites would have cost only $9.9 billion, saving $5.3 billion. n If Blacks had the benchmark rate of preventable hospitalizations, they would have had more than 470,000 fewer hospitalizations. Instead of costing $5.4 billion, preventable hospitalizations among Blacks would have cost only $1.7 billion, saving $3.7 billion. n If Hispanics had the benchmark rate of preventable hospitalizations, they would have had almost 170,000 fewer hospitalizations. Instead of costing $3.7 billion, preventable hospitalizations among Hispanics would have cost only $2.2 billion, saving $1.5 billion. n Because the overall rate among APIs was below the benchmark rate, there are no estimated excess preventable hospitalizations for this group. National Healthcare Disparities Report, 2011 195
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