Online Program

Hot spotting preventable hospitalizations to inform clinical practice and improve patient outcomes

Tuesday, November 3, 2015 : 3:30 p.m. - 3:50 p.m.

Rachael Weiss Riley, MPH, Community and Population Health, Montefiore Medical Center, Bronx, NY
Arthur E. Blank, PhD, Department of Family Medicine and Social Medicine, Center for the Evaluation of Health Programs/Division of Research, Bronx, NY
Earle C. Chambers, PhD, MPH, Department of Family and Social Medicine, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY
Peter Selwyn, MD, MPH, Department of Family and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
Introduction: Hospitalizations for ambulatory care sensitive (ACS) conditions are considered potentially avoidable with improved care and disease management in the community. However, clinical practices continue to intervene at the individual-level, rarely addressing local community factors that may influence population risk for hospitalization. This study evaluates spatial clustering of preventable hospitalizations for diabetes and chronic obstructive pulmonary disease (COPD)/asthma among adults residing in the Bronx, NY to identify high-risk local geographic areas.

Methods: Using 2012-13 inpatient data from a major Bronx medical center’s electronic health records, adult hospitalization rates for two ACS conditions, (1) diabetes long-term complications (n=2,722) and (2) COPD/asthma (n=4,177), are calculated at the US Census block group level and small area “hot spots” are mapped for both unique admission rates and super-user counts (patients with ≥2 readmissions). Spatial regression models are specified to assess the relationship between preventable hospitalization rates and neighborhood composition.

Results: Spatial analysis reveals significant spatial autocorrelation in both diagnoses; clusters of unique admissions and super-utilizers overlap in several areas, particularly in the northeast Bronx. Higher rates for diabetes and COPD/asthma are significantly associated (p<.05) with older neighborhood age composition, yet only diabetes is related to greater proportions of Hispanic and black residents.

Conclusions: The observed clustering of admission rates and super-utilizer counts for diabetes and COPD/asthma suggests a unique opportunity to target vulnerable communities to reduce unnecessary hospitalization. Future efforts focused on investigating contextual neighborhood factors that drive these localized hot spots will help clinicians and administrators develop community interventions to improve patient outcomes.

Learning Areas:

Chronic disease management and prevention
Public health or related research

Learning Objectives:
Discuss the clinical importance of hot spotting preventable hospitalizations. Identify clusters of preventable hospitalizations for diabetes and COPD/asthma among adults in the Bronx, NY. Identify next steps in developing community interventions aimed at reducing unnecessary hospitalizations.

Keyword(s): Chronic Disease Prevention, Geographic Information Systems (GIS)

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I've been a public health spatial epidemiologist for 9 years. I work at Montefiore as senior data analyst and have been working on ACS conditions for over 2 years.
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.