CA Reports Preventable Hospitalizations

comparing county-by-county rates of avoidable hospitalizations for 14 health conditions. It is the third state in the nation to do so, but apparently more states will follow soon.

"This data shows the picture of the state in terms of access to health insurance and access to primary care, and to some extent, whether patients follow instructions from their doctor," says Mike Kassis, a former deputy director of the Statewide Office of Healthcare Planning and Research who is an author of the report. "It's designed to keep patients out of the hospital in the first place."

The conditions selected are those that are sensitive to ambulatory care, and for which primary care and early intervention is known to prevent disease progression that results in a hospital stay.

The report shows a 10-year trend with some positive news. Preventable hospitalizations for 10 conditions such as chest pain dropped by more than 60% between 1999 and 2008.  Hospitalizations for pediatric gastroenteritis and chronic obstructive pulmonary disease declined by more than 40%.

But the report also shows some declines. The statewide rate for hospitalizations for hypertension has increased in that time frame by 36%, and most of that increase took place in 2007 and 2008. 

The agency also shows wide disparities between the counties and even within one county. For example, pediatric hospitalization rates in Alameda County, which contains Oakland, were nearly 2.5 times the statewide average.

Nearly four million hospital admissions in 2008, roughly one in 10, could have been avoided if acute conditions or chronic diseases that provoked hospitalization were prevented or better managed, according to a report from the Agency for Healthcare Research and Quality.

The report did not look at specific regions for individual counties because of concerns that patients' privacy might be compromised in smaller counties. But it did subdivide large metropolitan Los Angeles into regions, and found that the so-called south service planning area has almost 3.3 times greater asthma hospitalization rates than the state.

That may indicate that adding asthma clinics in that area might be a good idea, Kassis says. Likewise, some areas of the state are showing high hypertension rates as well as obesity rates, which may be helped with improved healthcare access.

In addition to pediatric asthma, hypertension, chest pain, pediatric gastroenteritis and COPD, the report lists rates of preventable hospitalizations for perforated appendix, congestive heart failure, dehydration, bacterial pneumonia, urinary tract infection, adult asthma and lower extremity amputation as a complication of diabetes and short-term complications from diabetes.

Kassis says that over time, more hospital-and county-specific information will be fine-tuned, and will be sent to county public health departments to better identify local needs for primary care.

So far, Kassis says, California is the third state in the nation to list such data, joining Maine and Hawaii. But more are expected to use a tool offered by the Agency for Healthcare Research and Quality that will eventually allow states to be compared with each other and with the national average.