BACKGROUND: Potentially preventable hospitalizations (PPHs) are a validated quality indicator that comprise 12 conditions where high-quality outpatient health care could have prevented hospitalization. The PPH conditions are classified as acute or chronic and reflect the timeliness or effectiveness of outpatient care, respectively. We aimed to describe trends in the PPH rate among American Indian/Alaska Native (AI/AN) persons by using Indian Health Service (IHS) data for 2008–13.
METHODS: We obtained inpatient data for AI/ANs from the IHS National Patient Information Reporting System (NPIRS) for 2008–13. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the acute and chronic PPH conditions as defined by the Agency for Healthcare Research and Quality technical specifications. We used Poisson regression to calculate and compare annual crude PPH rates overall and by geographic region among the IHS user population, defined as persons who had >1 health care service every 3 years that was reported to NPIRS.
RESULTS: Of the 383,032 hospitalizations occurring in AI/ANs during 2008–13, 28,786 (7.5%) were for acute and 29,336 (7.7%) for chronic PPH conditions. A majority of PPHs occurred in adults aged 45–84 years (51%); the PPH rate was highest among adults aged >85 years (73.3/1,000 persons). The PPH rate for acute conditions declined from 5.9/1,000 persons in 2008 to 4.7/1,000 in 2012 (P <0.001) before increasing to 5.4/1,000 in 2013 (P <0.001). The PPH rate for chronic conditions declined from 5.6/1,000 persons in 2008 to 4.9/1,000 in 2012 (P <0.001) before increasing to 5.9/1,000 in 2013 (P <0.001). The average annual PPH rate for acute conditions was lowest for the North Plains East IHS administrative region (1.8/1,000) and highest for the Alaska region (7.3/1,000 persons), and for chronic conditions was lowest for the North Plains East region (2.3/1,000) and highest for the East region (10.8/1,000).
CONCLUSIONS: Outpatient health care quality improved annually during 2008–12, as measured by reductions in PPH rates. The PPH rate increased from 2012 to 2013, suggesting a decline in the timeliness and effectiveness of outpatient care. Our analysis represents a starting point for further investigation to determine the underlying causes of these changes in PPH rates. Understanding the reasons for the differences in the PPH rates between regions could inform the development of targeted quality improvement interventions. Our results provide a baseline for evaluating the impact of future interventions to improve IHS outpatient health care quality.