Preventable Hospitalizations for Chronic Conditions
In 2023, nearly 80% of the 270,647 preventable hospitalizations in adults occurred for a chronic condition. With access to high-quality outpatient care, many of the 217,872 hospitalizations may have been prevented.
Why Are Chronic 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 Chronic Condition PQIs are part of a broader collection that includes Acute Condition PQIs and Diabetes Condition PQIs.
Key Findings – 2019 to 2023
- The percentage change of the Statewide RAR for Chronic Composite Index decreased by 13.3% (870.3 to 754.2). Over this period there was an annual average percentage change of -3.5% for the Statewide RAR for Chronic Composite.
- The percentage change of the Statewide RAR for Asthma in Younger Adults decreased by 36.7%, Heart Failure decreased by 8.9%, Hypertension increased by 4.4% and Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults decreased by 53.0%.
- The Statewide RAR for every Chronic Condition-related PQI decreased except Hypertension. In 2023, the Statewide RAR for Chronic Composite conditions was 754.2, with component rates of 16.4 for Asthma in Younger Adults, 370.9 for Heart Failure, 52.2 for Hypertension and 144.1 for COPD or Asthma in Older Adults.
- The largest three percentage increases in RARs for Chronic Composite conditions are seen in the Del Norte (12.9%), Amador (12.7%) and San Bernardino (1.5%) counties.
- The largest three percentage decreases in RARs for Chronic Composite conditions are seen in the Sierra (52.4%), Mono (44.4%) and Nevada (39.6%) counties.
Which Counties May Have Greater Unmet Chronic 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 13.3% decrease in the Statewide RARs for Chronic 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 Chronic condition-related PQIs can help inform the discussion about whether access to quality outpatient Chronic disease treatment in a community is adequate:
Non-Diabetes Indicators
- Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults [adults aged 40 and older] (PQI #5) – A group of lung conditions that cause breathing difficulties.
- Hypertension (PQI #7) – A condition where either the systolic pressure or diastolic pressure is too high.
- Heart Failure (PQI #8) – A condition where the heart cannot pump effectively enough to meet the bodies need for blood.
- Asthma in Younger Adults [between ages 18-39] (PQI #15) – A lung condition that causes breathing difficulties.
Diabetes-Included Indicator
- Chronic Composite Indicator (PQI #92) includes the Non-Diabetes Indicators above and Diabetes-Related Indicators (PQI: #1, #3, #14, #16). For detailed data regarding the Diabetes Indicators, refer to the Diabetes Condition PQIs report.
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