Preventable Hospitalizations for Acute Conditions
In 2023, nearly 20% of the 270,647 preventable hospitalizations in adults occurred for an acute condition. With access to high-quality outpatient care, many of the 52,775 hospitalizations may have been prevented.
Why Are Acute Condition PQIs Important?
The Agency for Healthcare Research and Quality’s (AHRQ’s) Prevention Quality Indicators (PQIs) are a set of measures of adult hospitalizations for ambulatory care-sensitive conditions that evidence suggests may have been avoided through access to quality outpatient care. The PQIs are calculated as Risk-Adjusted Rates (RAR) and counties with lower rates have a lower relative burden of hospitalizations for the given disease-related issues.
The PQIs provide a good starting point for assessing the quality of health services in a region. They can identify gaps in primary care access or outpatient services in a community and highlight potential health care quality problem areas that might need further investigation.
These Acute Condition PQIs are part of a broader collection that includes Diabetes Condition PQIs and Chronic Condition PQIs.
Key Findings – 2019 to 2023
- The percentage change of the Statewide RAR for Acute Composite Index decreased by 22.7% (241.4 to 186.6). Over this period there was an annual average percentage change of -6.2% for the Statewide RAR for Acute Composite.
- The percentage change of the Statewide RAR for Community-Acquired Pneumonia decreased by 25.3% and Urinary Tract Infection decreased by 19.6.
- The Statewide RAR for every Acute Condition-related PQI decreased. In 2023, the Statewide RAR for Acute Composite conditions was 186.6, with component rates of 96.7 for Community-Acquired Pneumonia and 89.9 for Urinary Tract Infections.
- The largest three percentage increases in RARs for Acute Composite conditions are seen in the Shasta (13.4%), Madera (12.8%) and Mono (1.5%) counties.
- The largest three percentage decreases in RARs for Acute Composite conditions are seen in the Inyo (66.8%), Sierra (60.8%) and Tehama (57.2%) counties.
Which Counties May Have Greater Unmet Acute Disease Outpatient Needs?
The Map & County Rankings dashboard shows RARs for a selected PQI and year. Greater access to care is generally reflected by lower hospitalization rates. In this visualization, counties with higher hospitalization rates are distinguished from those with lower hospitalization rates using the California statewide rate as a baseline. Counties with higher hospitalization rates are an indicator for potential unmet outpatient care. The ranking chart shows the counties with the lowest RARs for a chosen PQI and year.
The Statewide & Regional Comparison tab provides two views of RARs. The All Counties dashboard allows for a graphical view of RARs ordered lowest to highest for a chosen PQI and year. The Regions dashboard allows for a narrower county view of RARs by selecting a California Region.
Note: Rankings are not an indicator of which counties have the best outpatient care but simply list the lowest to highest RAR. Counties that saw 0 hospitalizations or a very low number of observations are often listed near the top and should be interpreted with caution.
How Have Individual Counties’ Acute Disease Hospitalizations Changed Over Time?
The County-Level Trends dashboard looks at RARs over 2019 to 2023 for a singular indicator or all selected PQIs. This allows a view of hospitalization rates over time, which can be used to assess the year-to-year hospitalization rate change and compare county trends to the California statewide rate.
From 2019 to 2023, there were substantial changes in hospitalization rates with a 22.7% decrease in the Statewide RAR for Acute Composite Index. The most common trend seen during this timeframe was an overall decrease in hospitalization rates in 2020 and 2021. The impact of COVID may have been the primary reason for the decreases in these rates. Changes in rates may also be due to the implementation of programmatic and policy interventions, or a lack of such interventions.
How HCAI Created This Product
Composite Indicators combine all hospitalizations across multiple related PQIs into one comprehensive indicator group. This measure allows for a view of broader conditions rather than a specific PQI.
The three individual acute condition-related PQIs can help inform the discussion about whether access to quality outpatient acute disease treatment in a community is adequate:
- Community-Acquired Pneumonia (PQI #11) – A bacterial lung infection that can cause breathing problems and other symptoms and is acquired outside of the hospital setting.
- Urinary Tract Infection (PQI #12) – An infection in any part of the urinary system (kidneys, ureters, bladder, urethra).
- Acute Composite (PQI #91) – Includes any conditions mentioned above.
About the Risk-Adjusted Rate (RAR): The RAR provides a comparative metric for understanding how specific disease-related hospitalizations vary across California counties.
- The RAR variable is calculated by adjusting for Age and Assigned Sex at Birth and is calculated per 100,000 state or county population.
- Counties with lower RARs have a lower relative burden of hospitalizations for the given disease-related issues.
Note: The RARs are adjusted for Age and Assigned Sex at Birth and are calculated per 100,000 state or county population. The PQI software program calculates RARs regardless of the number of cases available. However, PQI rates based on only a few cases should be interpreted with caution.
Additional Information
Topic: Healthcare Quality
Source Link: Rates of Preventable Hospitalizations for Selected Medical Conditions by County (LGHC Indicator)
Citation: HCAI – Patient Discharge Data – Preventable Hospitalizations for Acute Conditions; Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators, SAS Software, PQI Version v2023 (2019-2022, ICD-10-CM) and PQI Version v2024 (2023, ICD-10-CM).
Temporal Coverage: 2019–2023
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually