221538 Primary Care Supply as Predictor of Potentially Avoidable Adult Hospitalizations in Illinois

Monday, November 8, 2010

Martin MacDowell, DrPH, MBA, MS , National Center for Rural Health Professions, University of Illinois Health Sciences Center at Rockford, Rockford, IL
Michael Berbaum, PhD , Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL
  
Objective: To examine the relationship between the chances of potentially avoidable adult hospitalizations and whether or not an adult patient resides in a zip code that is a primary care shortage area adjusting for confounding factors.

Methods: AHRQ has identified hospital admissions related to ambulatory care sensitive conditions (ACSCs). De-identified inpatient data was obtained from the Illinois Dept. of Public Health. Discharges from 2003-2007 of 6,662,267 of Illinois residents aged 18 or older were examined to classify whether or not each hospitalization was due to an ACSC. Zip codes are identified as Primary Care Health Professional Shortage Areas (PC-HPSAs) by the Centers for Medicare and Medicaid Services. In this study if any zip code population group was identified as having a shortage, the entire ZIP code was classified as a Primary Care HPSA. Both descriptive and analytic analyses were done using SPSS 17. Since hospitalization data was at the individual level and whether an area is a primary care HPSA is a group level variable, Generalized Estimating Equations (GEE) were used to analyze the clustered data for effects of residing in a primary care shortage area adjusting for zip code level covariates measures of income, race/ethnicity, education, and housing.

Results: Descriptive findings indicated 13.9% were ACSC hospitalizations. A higher proportion of males than females (15.1 vs.13.1%), urban than rural (17.8% vs. 13.2%) and patient residing in versus outside of a shortage area (17.1% vs 13.4% had an ACSC hospitalization, (Chi-square, p <.01). ). Initial multivariate results indicate residents residing in a primary care shortage area had about a 5% greater likelihood of an ACSC hospitalization than residents not living in a primary care HPSA adjusting for the effects of covariates (gender, age, and socioeconomic factors). Implications of analysis results related to primary care workforce policies will be discussed.

Learning Areas:
Administration, management, leadership
Program planning
Provision of health care to the public
Public health or related research

Learning Objectives:
Participants w ill be able to: 1) Identify and describe the reasons for potentially avoidable adult hospital admissions that are termed by AHRQ as Ambulatory Care Sensitive Conditions (ACSC) hospitalizations and related patterns in Illinois 2) Explain how multilevel multivariate analysis is useful and the findings related to the major predictors of ACSC hospitalizations using patient level statewide hospital discharge data as well as zip code level characteristics.. 3) Describe findings related to the importance of access to primary care within the zip code of patient residence as a predictor of adult ACSC hospitalization risk. 4) List policy interventions suggested by the analysis results that could reduce preventable adult hospitalizations.

Keywords: Access, Workforce

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I designed and conducted the research project
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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