Hospital admission may be driven by hospital bed capacity in some Tennessee County Hospitals

Background – Hospital care represents the largest component of overall health care expenditures. Differences in hospitalization rates among regions with similar demographics, socio-economic indices and health outcomes are thought to reflect differences in prevailing area-specific practice patterns and effectiveness of preventive services (ambulatory care sensitive conditions –ACSCs) associated with primary care coordination and hospital bed capacity. This study aims to assess differences in Tennessee hospitalization rates based on the above criteria.

Methods–Data from the Tennessee Hospital Discharge Data for 2006 was used to establish four medical service areas (MSAs) in contiguous counties with similar demographics, socio-economic indices and similar health outcomes. Per capita rates for total hospitalizations, ACSC hospitalizations, admissions for both low variation and high variation elective surgical procedures, and admissions for discretionary medical conditions were generated. Adjustments were made for age, gender, racial grouping, insurance payer, and co-morbid conditions for each MSA. Results Total admission rates to the local hospital were directly related to the staffed beds per MSA capita. One of the MSAs had significantly lower total admission rates, lower ACSC rates, and lower elective surgery rates. We found significantly higher elective surgical procedure rates, both to the local hospital and to hospitals anywhere in the state, from another MSA. Conclusions – This pilot study established the feasibility of using state-wide uniform discharge data to compare small areas within counties, with the goal of identifying exemplary systems that focuses on preventive services and reduction of avoidable hospitalizations from ACSCs.