Using Prevention Quality Indicators to Gauge Health System Performance

Research Objective:

Compare Agency for Healthcare Research and Quality (AHRQ) Prevention Indicators (PQIs) for community hospitals in Mississippi with PQIs to community hospitals across the United States. Determine implications for improving the health care system by using evidence-based preventions indicators to gauge the status of primary and preventive care.

Student Design:

Mixed-methods quantitative analysis of Mississippi and US hospitals discharge data using AHRQ's PQIs, review of literature, federal/state policies, and qualitative stakeholder interviews of health officials.

Population Studied:

PQIs for Mississippi hospitalized in 2010 (n = 40,753) for heart, diabetes, lung, and infection conditions defined by AHRQ using statewide, all-payer claims hospital discharge data.

Principal Findings:

Preventable hospital admission rate differences for PQIs in Mississippi versus the United States are each significantly (p<.05) higher as follows:

Heart condition (n = 14,251) rates: a) hypertension (34%); b) congestive heart failure (6%)

Diabetes condition (n = 6,150) rates: a) diabetes short-term complication (27%); b) diabetes, long-term complication (10%); c) uncontrolled diabetes (35%); d) lower-extremity amputations for diabetes (17%)

Lung condition (n = 9,282) rates: a) chronic obstructive pulmonary disease or asthma in older adults (11%); b) asthma in younger adults (9%)

Infection condition (n = 11,070) rates: a) bacterial pneumonia (8%); b) urinary tract infection (26%).

Research shows relationships between state quality health care rankings, Medicare health care spending, and health workforce compositions. Higher health spending is associated with lower state quality rankings. States with higher per capita concentrations of health provider specialists have lower rankings in health care quality. Mississippi clearly illustrates these relationships by ranking low in health care quality, high in Medicare dollars spent, low in per capita general practitioners, and high in per capita specialists.

Conclusions:

Mississippi also ranks poorly in preventable health outcomes such as hospitalizations, premature death, and disability including high rates of leg amputations. Stakeholder scans indicate recognition of the problem and steps in progress to improve health care quality. The challenge is particularly daunting for a state with low penetration of managed care, low investment in public health and high burdens of chronic disease. Examination of actions in other states reveals strategies to enact a few comprehensive, interrelated policies to address workforce development and education payment reform, data collection, and quality measurement.

Implications for Policy, Delivery or Practice:

Changes are occurring rapidly in health care, so providers must adapt to new rules and structures. This dynamic environment provides an opportunity for providers, health care payers, and educators to ensure that changes work in concert to shift the health care system toward prevention and primary care rather than continuing to manage the consequences of delayed care. Other states should consider using PQIs to gauge the status of their preventive and primary health care systems, particularly in light of rapid health system changes.