- Discharge rate among the Medicare population for diagnoses that are amenable to non-hospital based care.
Preventable Hospitalizations is a measure of the discharge rate of Medicare enrollees aged 65 to 99 years with full Part A entitlement and no health maintenance organization (HMO) enrollment from hospitals for ambulatory care-sensitive conditions. Ambulatory care–sensitive conditions are optimally treated with outpatient care, potentially preventing the need for hospitalization or conditions in which early intervention can prevent complications or more severe disease. These conditions are based on ICD-9-CM diagnosis codes and include: convulsions, chronic obstructive pulmonary disease (COPD), bacterial pneumonia, asthma, congestive heart failure (CHF), hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and dehydration. The 2014 ranks are based on 2012 data from The Dartmouth Atlas of Health Care.
The rate of preventable hospitalizations ranges from a low of 28.2 discharges per 1,000 Medicare enrollees in Hawaii to over 90 discharges per 1,000 Medicare enrollees in Kentucky and West Virginia. The national average is 62.9 discharges per 1,000 Medicare enrollees, down from 64.9 discharges last year. The decline in preventable hospitalizations has been relatively steady over the last 13 years from a rate of 82.5 discharges per 1,000 Medicare enrollees in the 2001 Edition.
Preventable hospitalizations reflect how efficiently a population uses the various health care delivery options as well as the quality of the primary health care received. Preventable hospitalizations often occur as a result of a failure to treat conditions early in an outpatient setting due to limited availability. These discharges are also highly correlated with general admissions and reflect the tendency for a population to overuse the hospital setting as a site for care. Preventable hospitalizations are more common in those who are uninsured, which often leads to large unpaid medical bills. They also financially burden health care systems, as these hospitalizations could have been avoided with earlier less costly interventions. Hospital care makes up the largest component of health care spending in the United States, totaling over $750 billion. Of that total, $25 billion is directly attributed to preventable hospitalizations.
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 Nyweide DJ, Anthony DL, Bynum JP, et al. Continuity of care and the risk of preventable hospitalization in older adults. JAMA Intern Med. 2013;173(20):1879-1885.