BACKGROUND: The Agency for Healthcare Research and Quality has compiled Prevention Quality Indicators (PQI), which help identifying adult potentially preventable hospitalizations (PPH). These are hospitalizations for which good outpatient care or early intervention could have potentially prevented needs for hospitalization. In this study, we analyzed the trend of adult PPH’s risk adjusted (RA) rates for chronic conditions in Texas to assess changes in the rates from 2005 to 2013. To our knowledge, this is the first trend analysis of PPH in Texas.
METHODS: Chronic PPH were identified by ICD-9 codes from Texas Inpatient Hospital Discharge Public Use Data files from 2005 to 2013. We assessed the following conditions among adults: angina (without procedures), congestive heart failure (CHF), hypertension, diabetes short-term complications, diabetes long-term complications, uncontrolled diabetes, lower-extremity amputation (among patients with diabetes), asthma in younger adults age 18 to 39, and chronic obstructive pulmonary disease (COPD) or asthma among adults age 40 years and older. Crude rates and RA rates, adjusted by sex and age, per 100,000 adults and 95% confidence intervals were calculated. Ordinary Least Squares (OLS) regression was used to examine trends of RA rates over the nine year period using SAS 9.4. For conditions with significant trends, percent change in RA rates were calculated for 2005 and 2013 for Texas and each county. SAS 9.4 and ArcGIS 10.3 were used to visualize the trend.
RESULTS: OLS regression showed significant decreases in PPH due to angina (p<0.0001), CHF (p<0.0001), diabetes long-term complications (p=0.001), uncontrolled diabetes (p=0.0006), and asthma in younger adults (p=0.003). There was a significant increase in PPH due to diabetes short-term complications (p<0.0001). There were no significant decreases or increases in PPH for hypertension (p=0.37), COPD and asthma (p=0.07), diabetes long-term complications (p=0.18), and lower-extremity amputation (p=0.07). The overall chronic PPH decreased significantly (p<0.0001).
There was a 67% decrease in RA rates for angina (28.7 to 9.4), 33% decrease for CHF (503.4 to 335.5), and 52% increase for diabetes short-term complications (43.4 to 65.9). Overall chronic PPH decreased 21% (1,133.5 to 897.7).
Among 158 reportable counties, 20.9% showed an increase and 79.1% showed a decrease in PPH due to CHF.
CONCLUSIONS: There were decreasing trends in RA rates for PPH due to angina, CHF, diabetes long-term complications, uncontrolled diabetes, and asthma in younger adults. There was an increasing trend in diabetes short-term complications. These results will inform public health interventions targeted at reducing PPH in Texas.