National Healthcare Disparities Report - LDI Health Economist

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Efficiency Comparisons with the 3 State achievable benchmark for the composite rate of preventable hospitalizations in 2008 are also used to estimate excess preventable hospitalizations by area income. Area income refers to the median income of the ZIP Code in which the patient resides. Figure 7.4. Excess number of potentially preventable hospitalizations, by income, 2008 2,500,000 Excess 2 Expected at Best Rate 2,000,000 Chapter 7 Hospitalizations 1,500,000 1,000,000 63 78 74 500,000 0 First Quartile (Lowest) Second Quartile Third Quartile Fourth Quartile (Highest) 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 residents of the neighborhoods in the lowest income quartile had the benchmark rate of preventable hospitalizations, they would have had more than 630,000 fewer hospitalizations (Figure 7.4). Instead of costing $7.8 billion, preventable hospitalizations among income quartile 1 residents would have cost only $3.3 billion, saving $4.5 billion. n If residents of income quartile 2 neighborhoods had the benchmark rate of preventable hospitalizations, they would have had almost 410,000 fewer hospitalizations. Instead of costing $6.7 billion, preventable hospitalizations would cost only $3.7 billion, saving $3.0 billion. n If residents of income quartile 3 neighborhoods had the benchmark rate of preventable hospitalizations, they would have had about 240,000 fewer hospitalizations. Instead of costing $5.4 billion, preventable hospitalizations would cost only $3.6 billion, saving $1.8 billion. n If residents of the highest income quartile neighborhoods had the benchmark rate of preventable hospitalizations, they would have had about 160,000 fewer hospitalizations. Instead of costing $5.5 billion, preventable hospitalizations would cost only $4.1 billion, saving $1.4 billion. Potentially Avoidable Hospitalizations Among Medicare Home Health Patients Many patients are hospitalized while receiving care from home health agencies, with resulting high costs and care transition problems. A number of these hospitalizations are appropriate. However, some hospital admissions could be prevented with better primary care and monitoring in these settings, or the patient could receive appropriate treatment in a less resource-intense setting. 196 National Healthcare Disparities Report, 2011
Efficiency Using the AHRQ PQIs, we track potentially avoidable hospitalizations among Medicare patients occurring within 30 days of the start of home health care. These patients may differ from patients who are predominantly admitted for avoidable conditions from home but are not receiving home health services. Some of these patients are receiving appropriate primary care and others have not visited a health care provider for years. In contrast, Medicare home health patients have regular contact with health providers, which should reduce rates of avoidable hospitalization. However, these patients are also more acutely ill, may become seriously ill when affected by a new illness, and may have multiple comorbidities. Medicare patients in these settings often have been hospitalized recently. Therefore, an avoidable hospitalization may represent a return to the hospital, perhaps against the expectation that the patient no longer needed acute care. For application to home health settings, the potentially avoidable stays are identified within a defined time period, 30 days, from the home health admission date. If a patient is hospitalized more than once in that period, only the first stay is recognized for the measure. Chapter 7 Data on home health patients come from Medicare fee-for-service (FFS) home health claims and Outcome and Assessment Information Set patient assessment information. These data are linked with Medicare Part A acute care hospital claims to determine hospitalizations for potentially avoidable conditions. Figure 7.5. Medicare home health patients with potentially avoidable hospitalizations within 30 days of start of care, by race/ethnicity, 2000-2010 8 7 White Black Other Asian Hispanic AI/AN 6 Hospitalizations 5 4 3 2 1 2000 2001 2002 2003 2004 2005 2006 2007 2008 20092010 Key: AI/AN=American Indian or Alaska Native. Source: Centers for Medicare & Medicaid Services, Outcome and Assessment Information Set linked with Medicare Part A claims (100%), 2000-2010. Denominator: Adult nonmaternity patients starting an episode of skilled home health care. Note: For this measure, lower rates are better. Rates standardized to the 2006 patient population according to Medicare enrollment category. Hispanics could include other races. All race categories could include Hispanics. n Between 2000 and 2010, hospitalizations for potentially avoidable conditions within 30 days of home health episode start declined from 5.0% to 3.6% (data not shown). n From 2000 to 2010, among all racial and ethnic groups except Asians, the percentage of potentially avoidable hospitalizations within 30 days of home health episode start significantly decreased (Figure 7.5). National Healthcare Disparities Report, 2011 197
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