Trends in potentially avoidable hospitalizations among adults in Tennessee, 1998-2006.

BACKGROUND: Potentially avoidable hospitalizations are inpatient admissions for certain conditions, called Ambulatory Care Sensitive Conditions (ACSCs), which can potentially be prevented by effective outpatient treatment of individuals who actively participate in their own care and engage in responsible personal behavior. Changes in the rates of ACSC hospitalizations over time may signal an improvement or deterioration in the quality and effectiveness of ambulatory care. These long-term trends may also suggest changes in the underlying factors such as lifestyle choices and dietary practices of individuals and families.

OBJECTIVE: This study presents data from the Tennessee Hospital Discharge Datasets on changes in ACSC hospitalizations as a percent of all hospitalizations for 1998-2006.

METHODS: Retrospective analysis of administrative data based on the UB-92 claims forms submitted by all short-term acute-care hospitals in Tennessee.

RESULTS: Total ACSC hospitalizations in Tennessee increased by 4.2 percent between 1998 and 2006, while the total costs for ACSC hospitalizations decreased by 1.8 percent in constant 2006 dollars. In comparison, total admissions for all conditions increased by 15 percent during 1998-2006 while total hospital costs for all conditions increased by 21 percent. The rate of increase in ACSC hospitalization varied according to patient's race, insurance type, and whether the patient's health plan is managed care or fee-for-service. ACSC patients admitted through an emergency department outnumbered their counterparts who were not admitted through an emergency department by a factor of more than two throughout 1998-2006.

CONCLUSIONS: Our analysis of long-term trends of ACSC hospitalizations in Tennessee reveals a mixed bag of good news and bad news. In 1998-2006, ACSC hospitalizations rose at a much lower rate than overall hospitalizations for all conditions. Meanwhile, the costs of ACSC hospitalization in 2006 constant dollars decreased while the costs of overall hospitalizations increased. Minority groups such as blacks and patients insured under TennCare did not experience much decline in ACSC hospitalizations, especially in the rates of chronic ambulatory-care sensitive conditions, when compared with their white and commercially-insured counterparts. Patients whose care was managed experienced smaller declines in ACSC hospitalizations than those not under managed care. Finally, the number of ACSC hospitalizations admitted through an ED outnumbered those admitted through the regular hospital admission department during the study period, and the gap between the two sources of admissions grew larger over time.