Preventable Hospitalizations for Chronic Conditions

Over 175,000 hospitalizations for chronic conditions were identified in adults in the 2020 California inpatient data that may have potentially been prevented with access to high-quality outpatient care. 

Why are Chronic Condition PQI’s Important?#

The Agency for Healthcare Research and Quality’s (AHRQ’s) Prevention Quality Indicators (PQIs) measure potentially avoidable hospitalizations for chronic conditions (including diabetes, asthma, hypertension, and heart failure) at a Statewide and County level. Lower hospitalization rates for these conditions are indicators of greater access to care.

The PQIs provide a good starting point for assessing the quality of health services in a region. They can provide a check on 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 Diabetes PQIs and Acute Condition PQIs.

Which Counties May Have Greater Unmet Chronic Disease Outpatient Needs?#

The Prevention Quality Chronic Composite indicator (PQI #92) includes hospitalizations for any of the following conditions: asthma/Chronic Obstructive Pulmonary Disease (COPD), hypertension, heart failure, or diabetes (includes diabetes with short-term complications, long term complications, uncontrolled diabetes, and lower-extremity amputation). Greater access to care is reflected by lower hospitalization rates. In this visualization, counties with a higher hospitalization rate are distinguished from those with a lower hospitalization rate, indicating a potential unmet outpatient care need. 

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with greater scrutiny.

How do Individual Chronic Disease Indicators Compare Among Counties?#

The individual Prevention Quality Chronic Disease indicators allow county-to-county comparisons for each of the measures. This level of granularity can help determine the focus of chronic disease intervention(s) needed in a county. The diabetes indicators are encompassed within the Chronic Composite (PQI #92) but are not individually displayed in this visualization. For individual diabetes indicators data, refer to the “Preventable Hospitalizations for Diabetes” report.

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with greater scrutiny.

How Have Individual Counties’ Chronic Disease Hospitalizations Changed Over Time?#

This visualization shows differences in the Prevention Quality Chronic Composite (PQI #92) hospitalization rates from year to year, which can be used to assess whether the rates are increasing or decreasing. The visualization can also show the changes in each of the individual chronic condition measures. The changes in rates may be due to the implementation of or lack of programmatic and policy interventions.

Note: The risk-adjusted rates are age, sex, and poverty adjusted and are calculated per 100,000 state or county population. The PQI software calculates the rates regardless of the number of cases available. Rates based on only a few cases should be interpreted with caution.

Which Chronic Disease PQI Measures are Included in this Analysis?#

This analysis focuses on the Prevention Quality Chronic Composite (PQI #92), which includes the Non-Diabetes and Diabetes indicators below. Detailed data for the Non-Diabetes indicators are also included in some of the visualizations. For detailed data regarding the Diabetes indicators, refer to the “Preventable Hospitalizations for Diabetes” report.

Non-Diabetes Indicators#

• Chronic Obstructive Pulmonary Disease (COPD) or Asthma in Older Adults (PQI #5) – adults aged 40 and older
• Hypertension (PQI #7)
• Heart Failure (PQI #8)
• Asthma in Younger Adults (PQI #15) – adults between ages 18-39

Diabetes Indicators#

• Diabetes Short-term Complications (PQI #1) – diabetes with ketoacidosis, hyperosmolarity, or coma
• Diabetes Long-term Complications (PQI #3) – diabetes with renal, eye, neurological, circulatory, or complications not otherwise specified
• Uncontrolled Diabetes (PQI #14) – diabetes without mention of short-term or long-term complications
• Lower-Extremity Amputation among Patients with Diabetes (PQI #16) – diabetes with a procedure of lower-extremity amputation (except toe); e.g., removal of leg or foot

Other PQI Visualizations:

• Preventable Hospitalizations for Acute Conditions
• Preventable Hospitalizations for Diabetes

Additional Information#

Topic: Healthcare Quality
Temporal Coverage: 2016-2020
Spatial/Geographic Coverage: Statewide and County
Frequency: Annual
Source Link: Rates of Preventable Hospitalizations for Selected Medical Conditions by County (LGHC Indicator)
Citation: HCAI Patient Discharge Data; Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators, SAS Software,  Version v2021 (2016-2020, ICD-10-CM).