Community Need Linked to High Incidence of Avoidable Hospital Admissions

Initial research by Solucient indicates that communities with the greatest healthcare needs also experience a high incidence of hospital admissions for preventable conditions that can be effectively treated outside the hospital.

If the correlation is confirmed by additional analysis, healthcare providers would ultimately be able to use this information to improve their community's health status by using targeted consumer outreach to increase the rate of outpatient care for these conditions, thus avoiding expensive and inefficient hospitalizations.

The linkage is indicated by a correlation between Solucient's Community Need Index (CNI) and the Prevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality (AHRQ).

CNI was developed jointly by Solucient and San Francisco-based Catholic Healthcare West. It uses demographic and socioeconomic statistics to identify local communities with the greatest healthcare needs based on five barriers to healthcare: income, culture/language, education, insurance and housing. It then assigns a score to every ZIP code, indicating the relative need of each local community in comparison to national norms.

"The team's initial work on the CNI identified a strong correlation between socioeconomic factors and ambulatory sensitive conditions (ASCs)," notes Rich Roth, director of strategy and business development for CHW and the principal investigator for the CNI. "This new research further validates that initial finding and underscores the value of the index as an analytic, scientific method for determining community need."

AHRQ has defined 13 PQIs which measure rates of inappropriate hospital admissions for illnesses that can be effectively treated with high-quality, community-based primary care. The 13 indicators are diabetes (short-term complications), diabetes (long-term complications), diabetes (uncontrolled), perforated appendix, chronic obstructive pulmonary disease, hypertension, congestive heart failure, dehydration, bacterial pneumonia, urinary infection, angina, adult ashma and amputation of a lower extremity.

Initial analysis of 2004 Medicare inpatient data for more than 2,000 counties shows that for 12 out of the 13 preventable conditions, a high PQI rate is associated with a higher CNI score. The only exception is for a perforated appendix.

Healthcare providers can use information about high CNI scores to research targeted patient data to pinpoint which preventable conditions are present within a particular ZIP code in their community.

Once these preventable conditions are identified, the hospital can dedicate resources to meet specific community needs in individual areas, and educate consumers in the affected areas using targeted marketing and outreach programs about the availability of these resources.

As a result, these conditions should become more likely to be detected early and treated in outpatient settings. In turn, this should aid in preventing these conditions from becoming serious enough to warrant inpatient admissions, thus decreasing the number of avoidable expensive and inefficient inpatient admissions associated with these conditions.

Though the correlations are low, all are statistically significant and suggest that lower CNI is associated with better community health status. Next steps to validate this initial finding include adjusting for age and sex and determining rates based on the Medicare beneficiaries for a geographic area instead of the total population.