Adult Potentially Preventable Hospitalizations in Texas

Adult Potentially Preventable Hospitalizations in Texas

2014 Crossroads Conference:Navigating Health Care in West Texas

June 5, 2014

Mike Gilliam, Jr., M.S.W., M.P.H.Assessment & Benchmarking Specialist

Texas Department of State Health Services (DSHS)

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Adult Potentially Preventable Hospitalizationsin Texas (2007-2012)

• Since 2008, DSHS has educated communities and policymakers on the impact of these ten adult potentially preventable hospitalization conditions:

1. Bacterial Pneumonia;

2. Dehydration;

3. Urinary Tract Infection (UTI);

4. Angina (without procedures);

5. Congestive Heart Failure (CHF);

6. Hypertension;

7. Asthma;

8. Chronic Obstructive Pulmonary Disease (COPD);

9. Diabetes Short-term (ST) Complications; and

10. Diabetes Long-term (LT) Complications.

Adult hospitalizations for these conditions are considered “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.

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Bacterial Pneumonia is a serious inflammation of the lungs caused by an infection. Bacterial pneumonia primarily impacts older adults. Communities can potentially prevent hospitalizations by encouraging older adults and other high risk individuals to get vaccinated for bacterial pneumonia.

Dehydration means the body does not have enough fluid to function well. Dehydration primarily impacts older adults or institutionalized individuals who have a limited ability to communicate thirst. Communities can potentially prevent hospitalizations by encouraging attention to the fluid status of individuals at risk.

UTI is usually caused when bacteria enter the bladder and cause inflammation and infection. It is a common condition, with older adults at highest risk. In most cases, an uncomplicated UTI can be treated with proper antibiotics. Communities can potentially prevent hospitalizations by encouraging individuals to practice good personal hygiene; drink plenty of fluids; and (if practical) avoid conducting urine cultures in asymptomatic patients who have indwelling urethral catheters.

Angina (without procedures) is chest pain that occurs when a blockage of a coronary artery prevents sufficient oxygen-rich blood from reaching the heart muscle. Communities can potentially prevent hospitalizations by encouraging regular physical activity; smoking cessation; controlling diabetes, high blood pressure, and abnormal cholesterol; maintaining appropriate body weight; and daily administration of an anti-platelet medication (like low dose aspirin) in most individuals with known coronary artery disease.

CHF is the inability of the heart muscle to function well enough to meet the demands of the rest of the body. Communities can potentially prevent hospitalizations by encouraging individuals to reduce risk factors such as coronary artery disease, diabetes, high cholesterol, high blood pressure, smoking, alcohol abuse, and use of illegal drugs.

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Hypertension is a syndrome with multiple causes. Hypertension is often controllable with medications. Communities can potentially prevent hospitalizations by encouraging an increased level of aerobic physical activity, maintaining a healthy weight, limiting the consumption of alcohol to moderate levels for those who drink, reducing salt and sodium intake, and eating a reduced-fat diet high in fruits, vegetables, and low-fat dairy food.

Asthma occurs when air passages of the lungs become inflamed and narrowed and breathing becomes difficult. Asthma is treatable, and most flare-ups and deaths can be prevented through the use of medications. Communities can potentially prevent hospitalizations by encouraging people to learn how to recognize particular warning signs of asthma attacks. Treating symptoms early can result in prevented or less severe attacks.

COPD is characterized by decreased flow in the airways of the lungs. It consists of three related diseases: asthma, chronic bronchitis and emphysema. Because existing medications cannot change the progressive decline in lung function, the goal of medications is to lessen symptoms and/or decrease complications. Communities can potentially prevent hospitalizations by encouraging education on smoking cessation and minimizing shortness of breath.

Diabetes ST Complications are extreme fluctuations in blood sugar levels. Extreme dizziness and fainting can indicate hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), and if not brought under control, seizures, shock or coma can occur. Diabetics need to monitor their blood sugar levels carefully and adjust their diet and/or medications accordingly. Communities can potentially prevent hospitalizations by encouraging the regular monitoring and managing of diabetes in the outpatient health care setting and encouraging patient compliance with treatment plans.

Diabetes LT Complications include risk of developing damage to the eyes, kidneys and nerves. Risk also includes developing cardiovascular disease, including coronary heart disease, stroke, and peripheral vascular disease. Long-term diabetes complications are thought to result from long-term poor control of diabetes. Communities can potentially prevent hospitalizations by encouraging the regular monitoring and managing of diabetes in the outpatient health care setting and encouraging patient compliance with treatment plans.

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• Methodology to identify “Potentially Preventable Hospitalizations” was developed by the Agency for Healthcare Research and Quality (AHRQ). AHRQ is the lead federal agency responsible for research on healthcare quality costs, outcomes and patient safety.

• Potentially Preventable Hospitalizations are also referred to as Ambulatory Sensitive Conditions, Prevention Quality Indicators and/or Potentially Preventable Admissions/Events.

• Potentially Preventable Hospitalization data is based on primary diagnosis.

• Potentially Preventable Hospitalization data is based on county of residence – not the county where the individual was hospitalized.

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• The purpose of this information is to assist in improving healthcare and reducing healthcare costs.

• This information is not an evaluation of hospitals or other healthcare providers.

• This information can be used as a tool to assess a community’s outpatient healthcare system.

• Inpatient hospital data in Texas is available from the Texas Health Care Information Collection (www.dshs.state.tx.us/thcic), in the Center for Health Statistics, at DSHS.

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• *From 2007-2012, adult residents of Texas received approximately $47.4 Billion (B) in charges for 1,459,249 hospitalizations that were potentially preventable.

• *$47.4 B equals $2,483 for every adult Texan.

• *Allocation of the $47.4 B by Expected Primary Source of Payment:...Medicare $30.0 B(63.3%)…Private Health Insurance $ 8.5 B(18.0%)…Uninsured $ 4.6 B(09.7%)…Medicaid $ 3.2 B(06.8%)…Other $ 1.1 B(02.2%)

*Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

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• *Number of Hospitalizations: 1,459,249

• *Average Hospital Charge: $32,464

• *Average Length of Hospital Stay: 4.9 Days

• *Average Age of Individual Hospitalized: 63 Years


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Texas (U.S. Census 2010, Adult Population)White (Race): 72.2% Black (Race): 11.6% Other (Race): 16.2% Hispanic (Ethnicity): 33.6%

*Values of less than 3% are included in “Other”

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*Values of less than 3% are included in “Other” B means Billion M means Million

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Combined, Bacterial Pneumonia and CHF comprise:

•*43.3% (632,354) of admissions for Potentially Preventable Hospitalizations; and

•*50.2% ($23.8 B) of charges for Potentially Preventable Hospitalizations.


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Adult Potentially Preventable Hospitalizationsin Texas

AdultResidents ofTexas(2006-2010)

BacterialPneumonia

Dehydration UTI Anginaw/o procedures

CHF Hyper-Tension

Asthma COPD DiabetesST

DiabetesLT

Hospitalizations 250,721 68,557 160,599 14,984 296,953 51,817 77,900 145,200 45,192 108,078

*Mental Illness/SubstanceAbuse(SecondaryDiagnosis)

*32.5% *31.0% *36.1% *31.3% *20.6% *30.9% *37.0% *44.4% *29.3% *20.3%

*Alcohol and other Drug Diagnoses (Excluding Tobacco Use Disorder) are Significantly Underrepresented Due to Data Suppression Requirements.

Secondary Diagnosis of Mental Illness/Substance Abuse in Adult Potentially Preventable Hospitalizations in Texas (2006-2010)

For example, 32.5% of the 250,721 adult potentially preventable hospitalizations for Bacterial Pneumonia (2006-2010) had a secondary diagnosis of mental illness/substance abuse.

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In-depth data profiles are available with the following information:Years (2007-2012);Condition (Ten Conditions);County;Age Group;Sex;Race;Ethnicity;Zip Code of Residence;Hospitalized at;Average Length of Hospital Stay;Average Hospital Charge;Total Hospital Charges;Discharged to; andExpected Primary Source of Payment.

To request an in-depth profile, send an email to [email protected].

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LUBBOCK COUNTY: Adult ResidentsDiabetes Short-term Complications Potentially Preventable Hospitalizations (2007-2012)

Total Hospitalizations 1,133

Age Zip Code of Residence18-19 Years 04.2% 79403 13.2%20-29 Years 32.4% 79416 09.5%30-39 Years 19.8% 79423 07.8%40-49 Years 16.4% 79411 07.8%50-59 Years 12.8% 79415 07.7%60-69 Years 08.5% 79407 07.6%Other 05.9% 79412 07.1%

79413 06.5%Female 49.4% 79424 06.2%

Male 50.6% 79414 05.6%79404 05.6%

White (Race) 70.7% 79401 05.6%Black (Race) *19.4% Other 03.6%Other (Race) 09.9%

Hispanic (Ethnicity) *39.3% *The adult (18+) population of Lubbock County is approximately 09.0% Black and 28.6% Hispanic.

Example of In-Depth Data Profile:

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LUBBOCK COUNTY: Adult ResidentsDiabetes Short-term Complications Potentially Preventable Hospitalizations (2007-2012)

Total Hospitalizations 1,133

Place of Hospitalizations Expected Primary Source of Payment University Medical Center 68.0% Medicaid 17.9%Covenant Medical Center 26.3% Medicare 22.7%Other 05.8% Private Health Insurance 23.7%

Uninsured 32.5%Average Length of Stay 4.3 Days Other 03.2%Average Hospital Charge $26,694

Total Hospital Charges $30,244,581 Discharged to

Home/Self Care 87.0%Home Health 05.2%Skilled Nursing Facility 03.1%Other 04.2%

Example of In-Depth Data Profile:

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Efforts to Reduce Adult Potentially Preventable Hospitalizations

The 82nd Texas Legislature appropriated $2 M for DSHS to implement the Reducing Adult Potentially Preventable Hospitalizations Initiative in FY 12/13.

DSHS contracted with 16 counties to implement evidence-based interventions, through a community coordinated approach, to reduce hospitalizations and/or hospital charges among adult county residents for selected potentially preventable hospitalization conditions. Adult residents in each of the 16 counties had a hospitalization rate more than 50% higher than the state rate from 2005-2009.

Each of the 16 counties had a Project Contact that coordinates monthly coalition meetings to maximize implementation of one or more of the following evidence-based interventions: immunizations; patient education; community education; smoking cessation; healthcare provider education; diabetes self-management education; patient case management; nutrition & physical activity; weight management; glycemic control; and blood pressure control.

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County Hospitalization Condition(s) Project Contact EmailAngelina Bacterial Pneumonia, Dehydration & UTI Sharon Shaw (Angelina Co. & Cities Health District) [email protected]

Brooks Bacterial Pneumonia Diana Bill (Community Action Corp. of S TX) [email protected]

Ector Asthma & COPD Sherrill Rhodes (Medical Ctr. Health System) [email protected]

Grayson Bacterial Pneumonia, Dehydration & UTI John Teel (Grayson Co. Health Dept.) [email protected]

Hunt Bacterial Pneumonia & COPD Pam Andrews (Hunt Co. Health Dept.) [email protected]

Liberty Bacterial Pneumonia, CHF & COPD Steven Racciato (Health Ctr. of SE TX) [email protected]

Limestone Bacterial Pneumonia & CHF Kimberly Meyer (Limestone Medical Ctr.) [email protected]

Nacogdoches Dehydration & UTI Kinnie Douglas (Nacogdoches Memorial Hospital) [email protected]

Orange Bacterial Pneumonia, CHF & COPD Jarren Garrett (Baptist Hospitals of SE TX – Orange) [email protected]

Polk Bacterial Pneumonia, CHF & COPD Jerry Hathorn (Polk Co. Health Advisory Coalition) [email protected]

Red River CHF & COPD Marleah Drew (Lennox Health Resources) [email protected]

San Augustine Bacterial Pneumonia Sharon Shaw (Angelina Co. & Cities Health District) [email protected]

Tom Green Bacterial Pneumonia, UTI & COPD Dianna Spieker (Tom Green Co.) [email protected]

Trinity Bacterial Pneumonia, UTI & COPD Carl Dyer (Trinity Co.) [email protected]

Victoria Bacterial Pneumonia, CHF & Diabetes Robbyn Michalka (Texas AHEC East – Victoria Region)

[email protected]

Walker Hypertension & Diabetes Meredith Henry (Texas AgriLife – Walker Co.) [email protected]

FY12/13 Reducing Adult Potentially Preventable Hospitalizations Initiative (01/01/12 – 08/31/13)

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County Hospitalization Condition(s) Project Contact EmailAngelina Bacterial Pneumonia, Dehydration, UTI &

HypertensionAnn Watson (Angelina Co. & Cities Health District) [email protected]

Brooks Bacterial Pneumonia & Dehydration Diana Bill (Community Action Corp. of S TX) [email protected]

Ector Asthma, COPD & Diabetes Dianna Ruiz (Medical Ctr. Health System) [email protected]

Grayson Bacterial Pneumonia, Dehydration, UTI & COPD

Sandra Clark (Grayson Co. Health Dept.) [email protected]

Limestone Bacterial Pneumonia , CHF & COPD Kimberly Meyer (Limestone Medical Ctr.) [email protected]

Orange Bacterial Pneumonia, Angina, CHF & COPD

Jarren Garrett (Baptist Hospitals of SE TX – Orange) [email protected]

Polk Bacterial Pneumonia, Dehydration, CHF & COPD

Jerry Hathorn (Polk Co. Health Advisory Coalition) [email protected]

Red River CHF, COPD & Diabetes Tammy Lawing (Lennox Health Resources) [email protected]

San Augustine Bacterial Pneumonia & Hypertension Ann Watson (Angelina Co. & Cities Health District) [email protected]

Tom Green Bacterial Pneumonia, Dehydration, UTI & COPD

Dianna Spieker (Tom Green Co.) [email protected]

Trinity Bacterial Pneumonia, UTI, Hypertension & COPD

Carl Dyer (Trinity Co.) [email protected]

Victoria Bacterial Pneumonia, Angina, CHF & Diabetes

Robbyn Michalka (Texas AHEC East – Victoria Region)

[email protected]

Walker Hypertension, Asthma & Diabetes Meredith Henry (Texas AgriLife – Walker Co.) [email protected]

FY14/15 Reducing Adult Potentially Preventable Hospitalizations Initiative (09/01/13 – 08/31/15)DSHS re-contracted with 13 of the 16 counties funded in FY12/13.

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AdultResidents ofTexas(2006-2011)

BacterialPneumonia

Dehydration UTI Anginaw/o procedures

CHF Hyper-Tension

Asthmain

*YoungerAdults

COPDor

Asthmain **Older

Adults

DiabetesST

DiabetesLT

Risk-AdjustedRate Per 100,000

2011 297.5 85.5 199.1 15.8 307.0 51.5 30.1 366.0 46.1 107.3

2010 326.9 95.7 208.4 18.4 337.0 56.3 37.9 418.9 42.8 106.7

2009 344.7 112.0 206.0 24.1 353.5 55.6 40.5 432.5 41.0 104.8

2008 360.8 137.2 196.2 26.7 366.6 53.9 31.0 462.2 39.5 110.2

2007 408.6 152.8 206.5 32.4 424.6 58.6 36.5 414.0 37.8 110.2

2006 408.8 162.3 214.7 42.4 469.6 56.4 41.9 420.3 36.0 122.8

*18-39 Years of Age **40+ Years of Age

TRENDS: Adult Potentially Preventable Hospitalizations

Note: AHRQ recently released new methodology that separates Asthma Potentially Preventable Hospitalizations into two conditions: Asthma in *Younger Adults and COPD or Asthma in **Older Adults. The table above reflects this new methodology.

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Discharge Rate for Medicare Population:Diagnoses Amenable to Non-Hospital Based-Care

Texas U.S.

Number per 1,000 Medicare Enrollees

2013 Report (2011 data) 67.9 64.9

2012 Report (2010 data) 72.3 66.6

2011 Report (2009 data) 72.8 68.2

2010 Report (2008 data) 78.7 70.6

2009 Report (2007 data) 81.2 74.2

2008 Report (2006 data) 87.6 78.4

2007 Report (2005 data) 87.6 78.4

2006 Report (2004 data) 87.6 77.0

Source: America’s Health Rankings – United Health Foundation

Comparing the 2013 Report to the 2010 Report, the discharge rate in Texas decreased 13.7%, as compared to the discharge rate in the U.S. which decreased 8.1%.


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Adult ResidentsOverall Prevention Quality Indicator (PQI) Rate

FreestoneCounty

Red RiverCounty

TEXAS

Risk-Adjusted Rate Per 100,000

2011 1,974.9 4,451.5 1,357.7

2008 2,712.8 6,051.7 1,596.9


Overall PQI Rate is an AHRQ aggregate calculation of all adult potentially preventable hospitalizations.

Under the leadership of the county judge in 2008, community health coalitions in Freestone and Red River County worked with DSHS to use the potentially preventable hospitalization data to attempt to reduce adult potentially preventable hospitalizations. For example, both counties implemented vaccine outreach campaigns targeting Bacterial Pneumonia.

From 2008 to 2011, the overall PQI rate for adult residents of:oFreestone County decreased 27.2%;oRed River County decreased 26.4%; andoTexas decreased 15.0%.

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Project Website (www.dshs.state.tx.us/ph)• State Profile;• Profiles on all 254 counties in Texas;• Clinical Interventions;• Maps illustrating the impact of potentially preventable hospitalization

conditions in Texas counties; and• Funded Counties (Reducing Adult Potentially Preventable

Hospitalizations Initiative) . Contact Information:Mike Gilliam, Jr.

(512)776-2708 [email protected]

Documents

Adult Potentially Preventable Hospitalizations in Texas