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Potentially Preventable Hospitalizations in Massachusetts Fiscal Years 2004 to 2008 July 2010

Potentially Preventable Hospitalizations in Massachusetts Fiscal Years 2004 to 2008 July 2010. Deval L. Patrick, Governor Commonwealth of Massachusetts Timothy P. Murray Lieutenant Governor. JudyAnn Bigby, M.D., Secretary Executive Office of Health and Human Services

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Potentially Preventable Hospitalizations in Massachusetts Fiscal Years 2004 to 2008 July 2010

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  1. Potentially Preventable Hospitalizations in MassachusettsFiscal Years 2004 to 2008 July 2010 Deval L. Patrick, GovernorCommonwealth of Massachusetts Timothy P. MurrayLieutenant Governor JudyAnn Bigby, M.D., SecretaryExecutive Office of Health and Human Services David Morales, CommissionerDivision of Health Care Finance and Policy

  2. Table of Contents Study Goals and Policy Implications 2 Major Findings on Preventable Hospitalizations in Massachusetts 3 Methodology and Definitions 4 Prevalence and Costs of Preventable Hospitalizations in Massachusetts 5 Common Preventable Hospitalization Conditions in Massachusetts 8 Massachusetts versus National Preventable Hospitalization Rates 11 Trends in Preventable Hospitalizations in Massachusetts 13 Geographic Differences in Preventable Hospitalizations in Massachusetts 16 Preventable Hospitalizations by Payer 30 Preventable Hospitalizations by Race/Ethnicity 33 Preventable Hospitalizations by Age and Gender 42

  3. Study Goals and Policy Implications Background Preventable hospitalizations (PHs) are defined as the inpatient treatment of conditions for which outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications or more severe disease. These conditions are also known as “ambulatory care sensitive conditions” or ACSCs. Rates of PHs provide insight into the quality and accessibility of the health care system outside of the hospital setting rather than the performance of the hospitals themselves. This is because preventable hospitalizations are for primary care treatable conditions. Although other factors outside the direct control of the health care system can result in hospitalization, PHs provide a good starting point for assessing the quality and accessibility of health care in Massachusetts. Policy Implications The importance of measuring preventable hospitalizations (PHs) is two-fold: 1) it informs us about potential problems with access to primary care and coordination of care for particular health care conditions, in certain geographic areas, and/or for certain segments of the population, and 2) it identifies and quantifies potential system cost savings and quality improvement areas. Treatment in a hospital setting is more costly than treatment in a non-hospital setting, even for the same or similar health conditions. Factors such as patient education may be lacking for populations and localities with high preventable hospitalization rates. Analysis of preventable hospitalizations informs us about access to primary care in the community. It is not a measure of hospital performance. Differences in PH rates for specific conditions across age groups, genders, races/ethnicities, counties and payer types, or changes in these rates over time can help target particular segments of the population where access to primary care may be deficient and target areas of potential system cost savings. In addition, data from fiscal year 2008 can be used to assess changes and opportunities resulting from the Massachusetts Mandated Health Insurance Law, enacted in 2006, which, among other things, significantly expanded access to health insurance coverage. Study Questions This analysis aims to answer the following questions: 1) What is the magnitude of PHs in Massachusetts both in number and cost? 2) Which PHs are most prevalent in Massachusetts? 3) How do the rates of PH admission in Massachusetts compare to the nation and how have they changed over time? 4) How do PH rates vary across counties, payer groups, races/ethnicities, ages, genders? Data Source The data used in this analysis are from the DHCFP Inpatient Discharge Database. “Hospitalizations” are limited to inpatient hospitalizations. Included in the analysis are adult Massachusetts residents ages 18 and older. However, for trend analysis, all adult hospitalizations in MA hospitals, regardless of place of residence, were included in the analysis so trends are not confounded by changes in residence reporting implemented in fiscal year 2007. The unit of analysis for the most part is the preventable hospitalization (PH) admission rather than the individual patient, so multiple admissions per patient are counted individually. However, for condition specific analyses the ACSC is the unit of analysis and a condition is counted regardless of whether it was one of multiple conditions assigned to an admission. Therefore, an overall composite measure (or PH admission) is smaller than the sum of its parts since an admission may be associated with multiple conditions. Data are presented for fiscal years 2004 to 2008. Data for U.S. rates are from National Healthcare Quality Report AHRQ Prevention Quality Indicators applied to the 2006 HCUP State Inpatient Databases, March 2009.

  4. Major Findings on Preventable Hospitalizations in Massachusetts How prevalent are preventable hospitalizations (PH) in Massachusetts and what are the system costs? Potentially preventable hospitalizations accounted for 13% of inpatient admissions for Massachusetts residents age 18+ in FY08 and accounted for an estimated $639 million in hospital costs (8.5% of adult inpatient costs). What are the most common conditions that result in a potentially preventable hospitalization? Two conditions, one chronic and one acute, make up one-half of all preventable hospitalization admissions—congestive heart failure and bacterial pneumonia. The next leading preventable hospitalization conditions include chronic obstructive pulmonary disease (COPD), urinary tract infection (UTI), and asthma. How do the Massachusetts preventable hospitalization rates compare to those of the nation? Massachusetts rates of preventable hospitalization are lower than or similar to the national rates for 9 of the 12 ACSCs. For 3 conditions, COPD, UTI, and asthma, the risk adjusted preventable hospitalization rates in Massachusetts are higher than the nation. How have the rates of preventable hospitalization in Massachusetts changed over time? Although the volume of inpatient admissions has remained relatively stable from FY04 through FY08, there has been a 7% decrease in the rate of preventable hospitalization over the same period, with the most significant decline occurring between FY04 to FY06. However, this differed by condition. There was a steady increase in the rates of admission for hypertension and UTI, both increasing significantly faster than national rates. Rates decreased substantially for bacterial pneumonia, dehydration, angina and diabetes-related amputation in Massachusetts. Are there significant geographical differences in preventable hospitalization rates in Massachusetts? Residents in Essex, Plymouth and Worcester counties had an overall PH rate that was more than 10% higher than the state rate. Alternatively, the rates for Barnstable, Berkshire, Hampden, and Hampshire county residents were substantially lower. All counties experienced a decline in PHs from FY04 through FY08, with double-digit declines found for Berkshire, Hampshire and Norfolk county residents. The PH rates by specific condition vary significantly across the counties. For example, the PH rate for asthma for Plymouth county residents is more than 2 times the rate for Berkshire county residents. Which payer(s) experience the highest PH rates? For most payers, the percentage of all hospitalizations that are considered potentially preventable ranges between 7% (private payers) to 9% (Medicaid and CommCare). The percentage for Medicare is 18%. This result is not surprising since we are unable to adjust this measure for age or other factors associated with severity. The percentage for Medicare, however, has dropped by 1 percentage point from FY04. How do preventable hospitalization rates differ across races/ethnicities and are the rates higher or lower than expected? Blacks had significantly higher rates of preventable hospitalization for most conditions. Rates were higher among Blacks for diabetes-related conditions, asthma, congestive heart failure and hypertension when compared to either Whites or Hispanics. Furthermore, the rates for each of these conditions was higher than expected.* The rate of inpatient admission for COPD, on the other hand, was twice as high for Whites compared to Blacks and 4.5 times higher than Hispanics. How do PH rates differ by age and gender and are the rates higher or lower than expected? As might be expected, PH rates differ significantly by age group and by gender. For example, the rate of UTI is much higher for females than it is for males. However, PH rates for UTIs were higher than expected for both males and females. Rates were also higher than expected for both males and females for respiratory conditions. PH rates were higher than expected for long-term diabetes, hypertension, asthma, COPD and UTIs for those age 75+. On the other hand, rates were near or lower than expected for all other age groups for all but respiratory conditions (asthma and COPD) where rates were higher than expected for the younger age groups. *The expected rate is the rate of hospitalizations considered likely based on the rates observed in a larger dataset with similar demographics and diagnoses as Massachusetts

  5. Methodology and Definitions Methodology for Identifying PHs This analysis utilizes the methodology developed by the Agency for Healthcare Research and Quality (AHRQ) to identify PHs (Version 3.2). AHRQ defines “Prevention Quality Indicators” (PQIs)* that can be used with hospital inpatient discharge data to identify “ambulatory care sensitive conditions” (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention can prevent complications requiring hospitalization. This analysis informs us about access to primary care in the surrounding community. It is not a measure of hospital performance. This analysis uses risk adjusted rates (adjusted for age, gender, and socioeconomic status) when comparing state level rates to the U.S. and for comparing rates across counties. Two measures are calculated for age, gender, and race/ethnicity. The first is the observed (or raw) rate per 100,000 adult MA residents. The second is the ratio of the observed rate over the expected rate. The expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects a large proportion of the U.S. hospitalized or residential population. A ratio greater than 1 indicates hospitalizations greater than would be expected if Massachusetts had rates similar to the nation (also known as excess admissions). Most rates are expressed per 100,000 population (adult residents). The overall rate and rates compared across payer types are expressed as a percentage of total hospitalizations. All analyses were conducted for the population ages 18 and older. For county level analysis, Dukes, Nantucket, and Franklin counties were excluded due to population sizes less than 100,000. For race/ethnicity analysis, rates are reported for non-Hispanic Blacks (Blacks), non-Hispanic Whites (Whites), and Hispanics. Other races/ethnicities were removed from analysis due to small population sizes. Prevention Quality Indicators (PQIs) The PQIs in this analysis represent inpatient hospital admissions for the following ambulatory care sensitive conditions (ACSCs):* Chronic Conditions -Diabetes, short-term complications -Uncontrolled diabetes -Diabetes, long-term complications -Lower extremity amputations among patients with diabetes -Chronic obstructive pulmonary disease (COPD) -Hypertension -Congestive heart failure -Angina without procedure -Asthma Acute Conditions -Urinary tract infections -Dehydration -Bacterial pneumonia Two additional ambulatory sensitive conditions (low birth weight and perforated appendix) are also identified by ARHQ as prevention quality indicators but are not included in this analysis. *The specific definitions of the preventable hospitalization conditions and their corresponding ICD-9 CM codes can be found in AHRQ publication of Quality Indicators – Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions, Version 3.1 (March 12, 2007)

  6. How prevalent are Preventable Hospitalizations in Massachusetts and what are the system costs?

  7. 13% of Adult Inpatient Admissions in MA Were Potentially Preventable in FY08Preventable and Non-Preventable Inpatient Admissions for MA residents age 18+, FY08 Adult Inpatient Hospitalizations: 681,238 Preventable hospitalizations (PHs) accounted for nearly 13% of adult inpatient admissions in FY08.** PHs are identified by ambulatory care sensitive conditions (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization, or for which early intervention, such as patient education, can prevent complications requiring hospitalization. Non-PHs*: 87.4% of Adult Inpatient Hospitalizations PHs: 12.6% of Adult Inpatient Hospitalizations *Non-Preventable Hospitalizations (Non-PHs) are inpatient hospitalizations that are for conditions that are not considered ambulatory care sensitive. **Adult inpatient population is defined as those age 18+ (this group represents 85% of total inpatient hospitalizations for all ages).

  8. Preventable Adult Inpatient Admissions Cost an Estimated $639 Million in MA in FY08Costs of Preventable and Non-Preventable Inpatient Admissions for MA residents age 18+, FY08 Adult Inpatient Hospitalization Costs:$7.5 Billion Preventable hospitalizations (PHs) accounted for nearly 9% of adult inpatient admission costs, translating to an estimated $639 million in FY08.** Non-PHs*: 91.5% of Adult Inpatient Costs PHs: 8.5% of Adult Inpatient Costs *Non-Preventable Hospitalizations (Non-PHs) are inpatient hospitalizations that are for conditions that are not considered ambulatory care sensitive. **Adult inpatient population is defined as those age 18+ (this group represents 91% of total inpatient hospitalization costs for all ages). Cost estimates are based on fiscal year and assume a statewide cost to charge ratio of 48.68%. Costs are defined as costs paid to the hospital and do not necessarily include ancillary costs or any costs billed separately

  9. What are the most common conditions that result in a potentially preventable hospitalization?

  10. 61% of PHs in Massachusetts Were for Chronic Conditions in FY08Distribution of preventable hospitalizations by type for MA residents age 18+, FY08 Chronic conditions make up 61% of the more than 85,000 PHs. This proportion has increased by 3% since 2004, driven by a significant increase in PHs for hypertension over the 5-year period. This proportion is similar to the U.S. proportion as of FY07 (62%).* Acute PH Conditions: -Dehydration -Bacterial Pneumonia -Urinary Tract Infection • Chronic PH Conditions: • Diabetes-Related • COPD • Hypertension • Congestive Heart Failure • Angina without Procedure • Asthma *Data for U.S. proportion is from AHRQ Prevention Quality Indicators applied to the 2007 Nationwide Inpatient Sample. U.S. data presented here is available at http://qualityindicators.ahrq.gov/

  11. Congestive Heart Failure and Bacterial Pneumonia Most Common PHs in FY08Percent of Total PHs by Condition, FY08 The two leading PHs as a percent of total PHs are congestive heart failure (24%) and bacterial pneumonia (20%), making up nearly one-half of the estimated 85,665 total preventable hospitalizations (PHs) in FY08. Total Preventable Hospitalizations: 85,665

  12. How do Massachusetts Preventable Hospitalization rates compare with national rates?

  13. MA PH Rates Were Similar to or Lower than the Nation for 9 of 12 Conditions in FY08 Risk Adjusted Admission Rates per 100,000 Population for Individual PH Conditions, FY08: MA and U.S. The three PHs where Massachusetts was consistently higher than the U.S. average were COPD, asthma, and urinary tract infections. Massachusetts was lower than the U.S. average for preventable hospitalizations associated with short-term and uncontrolled diabetes, congestive heart failure, angina without procedure, and bacterial pneumonia. Data for U.S. rates are from National Healthcare Quality Report AHRQ Prevention Quality Indicators applied to the 2006 HCUP State Inpatient Databases, March 2009. U.S. data presented here is available at http://hcupnet.ahrq.gov/. Overall PH rates were not available.

  14. How have the rates of Preventable Hospitalization in Massachusetts changed over time?

  15. Rate of PHs Declined Between FY04 and FY06 then Remained Relatively Stable Index of Rate of Inpatient Hospitalizations and PH Status in Massachusetts, FY04-FY08 Rate of total inpatient hospitalizations and non-preventable hospitalizations remained relatively stable between FY04 and FY08. Between FY04 and FY06, there was a decrease in preventable hospitalizations. Then, between FY06 to FY08, the rate remained relatively stable. Overall, the rate of preventable hospitalizations declined by 6% between FY04 to FY08. Index: 2004=100 Population Adjusted Index

  16. Overall PH Rates in Massachusetts Decreased 7% FY04-FY08Change in Risk Adjusted PH Rates per 100,000 Population for Individual Conditions FY04-FY08 FY04 through FY08, there was a steady increase in the rates of PHs for hypertension and urinary tract infections. However, the rates of admission for diabetes-related amputation, angina, bacterial pneumonia, and dehydration each declined by more than 20%. Massachusetts shows similar changes to those on the national level (not shown) FY04-FY06. However, changes in the rates of urinary tract infections, uncontrolled diabetes, and hypertension have a significantly higher percentage increase in Massachusetts compared to national estimates. Rates are calculated for total inpatient hospitalization population rather than MA residents to account for residence reporting changes implemented in FY07. *Note that the numerator for overall rate is a discharge rather than an ACSC. The overall composite is therefore smaller than its parts since an admission may be associated with multiple conditions.

  17. Are there significant geographic differences in Preventable Hospitalization rates in Massachusetts?

  18. State Average=1,414 Plymouth, Essex, and Worcester County Residents Showed Highest PH Admission Rates in FY08Risk Adjusted PH Admission Rates by County Compared to the State Average, FY08* Plymouth, Essex, and Worcester county residents had a PH rate that was more than 10% higher than the state rate (1,414 per 100,000 population), while the rate for residents of Barnstable, Berkshire, Hampden and Hampshire counties was substantially lower.** On the local level, high preventable hospitalization rates may be associated with lack of primary care access or under utilization of both provider and patient education. Rate per 100,000 *Note that the numerator for overall rate is a discharge rather than an ACSC. The overall composite is therefore smaller than its parts. **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  19. Map of Overall Risk Adjusted PH Admission Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  20. Berkshire County Residents Showed Largest Decrease in PH Rates FY04-FY08Change in Risk Adjusted PH Rates per 100,000 Population for Overall Conditions, FY04-FY08* The rates of preventable hospitalizations (PHs) decreased FY04 through FY08 across all counties. Most notably, the rates for residents of Berkshire county decreased by nearly 13%. The decrease in Berkshire county was due to significant decreases in PH rates for angina and dehydration. Rates are calculated for total inpatient hospitalization population rather than MA residents to account for residence reporting changes implemented in FY07. *Note that the numerator for overall rate is a discharge rather than an ACSC. The overall composite is therefore smaller than its parts. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  21. State Average=126 PH Admissions for Long-Term Diabetes Highest in Essex, Suffolk, and Plymouth County Residents in FY08Risk Adjusted PH Rates for Long-Term Diabetes by County, FY08 Six counties had higher rates of preventable hospitalization (PH) admissions for long-term diabetes compared to the state average of 126 per 100,000 population. The rates for Essex, Plymouth, and Suffolk county residents exceeded the state average by approximately 14%.** Hampshire and Barnstable county residents had the lowest rates of PH admissions for long-term diabetes.** Rate per 100,000 **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  22. Map of Risk Adjusted Long-Term Diabetes PH Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  23. State Average=416 PH Admission Rates for Congestive Heart Failure Highest in Worcester and Essex County Residents in FY08Risk Adjusted PH Rates for Congestive Heart Failure by County, FY08 Residents of three counties (Essex, Plymouth, and Worcester) had higher rates (more than 10% higher) of preventable hospitalizations (PHs) for congestive heart failure compared to the state average of 416 per 100,000 population.** Berkshire and Hampshire county residents had the lowest rates of admission for congestive heart failure.** Rate per 100,000 **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  24. Map of Risk Adjusted Congestive Heart Failure PH Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  25. State Average=259 PH Admission Rates for COPD Highest in Plymouth, Worcester, and Essex County Residents in FY08Risk Adjusted PH Rates for COPD by County, FY08 Residents of four counties (Bristol, Essex, Plymouth, and Worcester) had higher rates (more than 15% higher) of preventable hospitalizations (PHs) for COPD compared to the state average of 259 per 100,000 population.** Suffolk and Hampden county residents had the lowest rates of admission for COPD.** Rate per 100,000 **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  26. Map of Risk Adjusted COPD PH Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  27. State Average=156 PH Admission Rates for Asthma Highest in Plymouth and Bristol County Residents in FY08Risk Adjusted PH Rates for Asthma by County, FY08 Residents of four counties (Bristol, Essex, Plymouth, and Worcester) had higher rates (more than 15% higher) of preventable hospitalizations (PHs) for asthma compared to the state average of 156 per 100,000 population.** Berkshire and Hampshire county residents had the lowest rates of asthma.** Rate per 100,000 **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  28. Map of Risk Adjusted Asthma PH Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  29. State Average=341 PH Admissions for Bacterial Pneumonia Highest in Worcester County Residents in FY08Risk Adjusted PH Rates for Bacterial Pneumonia by County, FY08 Essex, Plymouth, and Worcester county residents had significantly higher rates of preventable hospital (PH) admissions for bacterial pneumonia compared to the state average rate of 341 per 100,000 population.** Barnstable residents had admission rates for bacterial pneumonia conditions nearly 40% lower than the state average.** Rate per 100,000 **Differences were significant at p=<0.05. Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  30. Map of Risk Adjusted Bacterial Pneumonia PH Rates by County of Residence in FY08 Dukes, Nantucket, and Franklin counties are excluded because admission rates based on small population areas can be unreliable indicators.

  31. Which payers experience the highest PH rates?

  32. 18% of Hospitalizations among Medicare Patients Were Considered Preventable in FY08PH Admissions as a Percentage of Total Hospitalizations by Payer Type, FY08 In FY08, preventable hospitalization (PH) admissions for Medicare patients, as a percentage of total Medicare patient admissions, was double that of other payer groups. In large part this is likely due to the older age of the Medicare population. *All other payer includes: Worker’s compensation, other government payer, auto insurance, and missing or invalid payer data

  33. While Highest, PH Admission Rates among Medicare Patients Showed Decline FY04-FY08PH Admissions as a Percentage of Total Hospitalization by Payer Type, FY04-FY08 Although the rate of preventable hospitalization (PH) was highest for Medicare patients, that rate declined between FY05 and FY06 and remained flat since then. All other payer includes: Worker compensation, other government payer, auto insurance , and missing or invalid data. Percentages are calculated for total inpatient hospitalization population rather than MA residents to account for residence reporting changes implemented in FY07.

  34. How do Preventable Hospitalization rates differ across races/ethnicities and are the rates higher or lower than expected?

  35. Blacks Had Highest Rates of PH Admissions for All Diabetes-Related Conditions in FY08Observed Admission Rates per 100,000 Population for Diabetes-Related Conditions by Race/Ethnicity, FY08 In FY08, Blacks had much higher rates of hospitalization for all diabetes–related ambulatory care sensitive conditions than did Whites and Hispanics. The rate of admission for both long-term and short-term diabetes-related conditions for Blacks was more than 2.5 times the rate for Whites and Hispanics. Rate per 100,000 Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports.

  36. Excess PH Admissions for All Diabetes-Related Conditions Highest among Blacks in FY08*Excess Admissions for Diabetes-Related Conditions by Race/Ethnicity, FY08 Blacks experienced excess hospitalizations for both long-term and short-term diabetes-related conditions– Rates were between 140% and 180% higher than would be expected (if Massachusetts had a similar case mix to that of the nation).** Hispanics also had 52% excess hospitalizations for long-term diabetes-related conditions.** Percent Difference Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports. *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  37. Blacks Had Highest Rates of PH Admissions for Congestive Heart Failure and Hypertension in FY08Observed Admission Rates per 100,000 Population for Circulatory Diseases by Race/Ethnicity, FY08 In FY08, Blacks had higher PH rates of admission for congestive heart failure and hypertension compared to Whites and Hispanics. Most notably, Blacks had nearly 4 times the rate of admission for hypertension. Whites had a rate of admission for congestive heart failure twice the rate of Hispanics. All races/ethnicities showed equivalently low rates of angina without procedure. Rate per 100,000 Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports.

  38. 290% Excess PH Admissions for Hypertension among Blacks in FY08*Excess Admissions for Circulatory Diseases by Race/Ethnicity, FY08 High PH rates of admission for congestive heart failure and hypertension among Blacks were also in excess of what would be expected by 76% and 290%, respectively.** The high rate of congestive heart failure among Whites was in fact 12% lower than would be expected and low rates of hypertension among Hispanics were in excess of what would be expected by 42%. Percent Difference Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports. *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  39. PH Asthma Admissions Highest among Blacks, COPD Highest among Whites in FY08Observed Admission Rates per 100,000 Population for Respiratory Conditions by Race/Ethnicity, FY08 In FY08, Blacks were nearly three times as likely as Whites and nearly twice as likely as Hispanics to have an asthma-related preventable hospitalization. On the other hand, the rate of inpatient admission for COPD was twice as high among Whites compared to Blacks and 4.5 times higher than Hispanics. Rate per 100,000 Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports.

  40. Excess PH Asthma Admissions Highest among Blacks and Hispanics, COPD among Whites in FY08* Excess Admissions for Respiratory Conditions by Race/Ethnicity, FY08 Excess preventable admission patterns are similar to the observed admission rates for respiratory conditions. Blacks had 219% excess preventable hospitalizations for asthma while Hispanics had excess preventable hospitalizations of 111%.** Although Whites had significantly higher rates of admission for COPD, their rate was only 16% higher than would be expected.** Percent Difference Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports. *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  41. Whites Had Highest Rates of PH Admissions for All Acute Conditions in FY08Observed Admissions for Acute Conditions per 100,000 Population by Race/Ethnicity, FY08 Whites had the highest rates of preventable admissions for all acute ambulatory care sensitive conditions followed by Blacks and Hispanics. The highest rates were seen for bacterial pneumonia where Whites had a rate more than twice that of Hispanics. Rate per 100,000 Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports.

  42. Highest Excess PH Admissions for Acute Conditions Were Found in Black Population in FY08*Excess Admissions for Acute Conditions by Race/Ethnicity, FY08 Interestingly, while Whites had the highest rate of PH admissions for all acute ambulatory care sensitive conditions, Blacks showed the highest percent of excess PH admissions. Blacks had 9%, 15% and 49% more than expected PH admissions for bacterial pneumonia, dehydration, and urinary tract infections, respectively.** Hispanics and Whites had lower than expected admissions for bacterial pneumonia and dehydration. Percent Difference Due to changes in race/ethnicity reporting based on national standards OMB15, caution should be used when comparing FY08 rates with previous reports. *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  43. How do PH rates in Massachusetts differ by age and gender and are the rates higher or lower than expected?

  44. Nearly 50% of PH Admissions Were for those Ages 75 and Older in FY08Distribution of Observed PH Admission Rates Across Age Groups, FY08 Percentage of Preventable Hospitalizations Two-thirds of patients with potentially preventable hospitalization (PH) admissions are ages 65+. Nearly one-half are ages 75+. Although this may be partly due to different health needs and co-morbidities, which may exacerbate ACSCs for this group, analysis by age group may reveal areas where targeted intervention may improve access to primary care for certain segments of the population with particular conditions.

  45. Older Age Groups Had Higher Rates of PH Admissions for Progressive Diabetes Conditions in FY08Observed Rates of Admission per 100,000 Population for Diabetes-Related Conditions by Age Group, FY08 As expected, for diabetes-related conditions, the oldest age group (ages 75+) had the highest PH rates of admission for uncontrolled and long-term diabetes as well as diabetes-related amputations. These three conditions progress over time and therefore, are more likely to impact the oldest age groups. PH rates for short-terms diabetes-related complications were highest among those ages 18 to 39. Rate per 100,000

  46. Lower than Expected PH Admissions for All Ages Across Most Diabetes-Related Conditions in FY08* Excess Admissions for Diabetes-Related Conditions by Age Group, FY08 While the oldest age group (ages 75+) had the highest PH rates of admission for the majority of diabetes-related conditions, all but long-term diabetes-related conditions** were lower than would be expected. Rates of admission for uncontrolled diabetes were between 34% to 46% lower than would be expected across all age groups. Rates were higher than expected, however, for long-term diabetes. Percent Difference *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  47. MA Lower than U.S. PH Rates Across Age Groups for Most Diabetes-Related Conditions in FY08Observed Rates of Admission per 100,000 Population for Diabetes-Related Conditions by Age Group, FY08 : MA and U.S. Massachusetts PH rates for uncontrolled diabetes, short-term diabetes, and diabetes-related amputation were lower than the U.S across all age groups. The only instance were Massachusetts had higher rates than the U.S. was for long-term diabetes among those ages 75 and older (371 versus 366 per 100,000 population). Data for U.S. rates are from National Healthcare Quality Report AHRQ Prevention Quality Indicators applied to the 2006 HCUP State Inpatient Databases, March 2009. U.S. data presented here is available at http://hcupnet.ahrq.gov/.

  48. As Expected, PHs for CHF Significantly Higher in those Ages 75 and Older in FY08Observed Admission Rates per 100,000 Population for Circulatory Diseases by Age Group, FY08 In FY08, as would be expected, PH admission rates for congestive heart failure were significantly higher for those ages 65 and older. Rate per 100,000

  49. Majority of Circulatory Diseases Showed Lower than Expected PH Admissions for Most Ages in FY08*Excess Admissions for Circulatory Diseases by Age Group, FY08 Despite the fact that the 75+ age group had significantly higher PH rates for CHF, PH rates were only 8% higher than would be expected. The rate for hypertension among those age 75+ was 42% higher than expected.** Rates of admission for angina without procedure were 50% to 70% lower than would be expected across all age groups. Percent Difference *Excess admissions represent the ratio of the observed rate over the expected rate. Expected rates are derived from applying the average casemix (age, gender, and diagnoses) of a baseline file that reflects the US population. **Differences were significant at p=<0.05.

  50. MA Lower than U.S. PH Admission Rates by Age for Majority of Circulatory Diseases in FY08 Observed Rates of Admission per 100,000 Population for Circulatory Diseases by Age Group, FY08 : MA and U.S. Massachusetts PH admission rates for congestive heart failure and angina without procedure were lower than the U.S across all age groups. The only instance where Massachusetts had higher rates than the U.S. was for hypertension among those ages 75 and older (177 versus 164 per 100,000 population). Data for U.S. rates are from National Healthcare Quality Report AHRQ Prevention Quality Indicators applied to the 2006 HCUP State Inpatient Databases, March 2009. U.S. data presented here is available at http://hcupnet.ahrq.gov/.

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