- Discharge rate among the Medicare population for diagnoses that are amenable to non-hospital based care.
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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 2013 ranks are based on 2011 data from The Dartmouth Atlas of Health Care.
Preventable hospitalizations reflect how efficiently a population uses the various health care delivery options for necessary care as well as the quality of the primary health care received. Hospital care is expensive and makes up the largest component of health care spending in the United States, totaling over $750 billion. 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 place a financial burden on health care systems as they could have been avoided with earlier less costly interventions. Preventable hospitalizations are more common in those who are uninsured, which often leads to large unpaid medical bills.
The rate of preventable hospitalizations ranges from a low of 27.4 discharges per 1,000 Medicare enrollees in Hawaii to 103 discharges per 1,000 Medicare enrollees in Kentucky and West Virginia. The national average is 64.9 discharges per 1,000 Medicare enrollees, down from 66.6 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.
 The Kaiser Family Foundation. Trends in Health Care Costs and Spending. 2009;7692-02.
 Billings J. Recent findings on preventable hospitalizations. Health Aff. 1996;15(3):239.
 Weissman JS. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. 1992;268(17):2388.