Potentially Avoidable Pediatric Hospitalizations as Defined by the Agency for Healthcare Research and Quality: What Do They Tell Us About Disparities in Child Health?

Abstract

This study was conducted to determine if the Agency for Healthcare Research and Quality's newly established pediatric quality monitors, which measure potentially avoidable hospitalizations, are useful in detecting disparities in health care delivery. Data for all hospital discharges in Tennessee in 2002 were evaluated for the 5 pediatric discharge monitors identified by the Agency for Healthcare Research and Quality. These diagnoses were asthma, short-term complications of diabetes, gastroenteritis, urinary tract infection, and perforated appendix. Black children were more likely to be discharged with the diagnoses of asthma and short-term diabetes complications. Publicly insured children were more likely than commercially insured children to be discharged with each of the 5 potentially avoidable hospitalizations. The results show that black children and children insured by public programs have significantly different discharge rates for pediatric potentially avoidable hospitalizations than do white children or commercially insured children. This could be the result of less access to high-quality ambulatory care.

Factors Associated With Potentially Preventable Pediatric Admissions Vary by Diagnosis: Findings From a Large State

“…3 The $304 million in charges and 71 444 hospital days per year attributed to potentially preventable admissions in this study in Texas, the nation' s second largest state with 8.5% of the US population, 20 are proportional with estimates of $4 billion and 1 million hospital-days in 1 year in the 38 states in the Kids' Inpatient Database. 2 Similar to previous studies, 2,3,12 we found that black and Hispanic children had higher odds of potentially preventable admissions than white children who were hospitalized. Race and ethnicity have also been reported as risk factors for pediatric readmissions 21,22 and potentially preventable admissions for adults.…”

“…25 Inequalities in access to care may also contribute but would be expected to be more equal across conditions. Surprisingly, privately insured children had the highest odds that their admission was potentially preventable, with government insurance decreasing odds by 27% and being uninsured decreasing odds by 7%, whereas previous research has shown that uninsured 6 or publicly insured 12 children are more likely to have potentially preventable admissions than privately insured children. Patients with private insurance theoretically have better access to primary and preventative care 26 and, therefore, lower rates of potentially preventable admissions.…”

“…12 The prevalence of potentially preventable admissions in Texas according to the AHRQ definition (limited to 5 diagnoses) also differs from that found by using other definitions which may be more or less inclusive, such as Florida where 7% were potentially preventable, 7 the 33% rate found in 38 states, 2 the 28% rate at a single center based on admitting physician opinion, 8 and an 11% to 15% rate in New York. 3 The $304 million in charges and 71 444 hospital days per year attributed to potentially preventable admissions in this study in Texas, the nation' s second largest state with 8.5% of the US population, 20 are proportional with estimates of $4 billion and 1 million hospital-days in 1 year in the 38 states in the Kids' Inpatient Database.…”

“…12 Of note, AHRQ defines each preventable admission as one that might have been prevented with timely access to primary care or improvements to social determinants of health 9 such as environmental air quality for asthma; we will therefore refer to these as potentially preventable. Thus, not every asthma or gastroenteritis admission is considered potentially preventable, and each has specific age and comorbidity exclusionary criteria.…”

Community Household Income and Resource Utilization for Common Inpatient Pediatric Conditions

“…[1][2][3][4] Individual health is negatively affected by socioeconomic stressors, leading to poor health and higher health care utilization. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The complex interplay of clinical, social, and other factors is illustrated in Fig 1. 25 Children from low socioeconomic status (SES) families have myriad health problems. 5,13,20,21 Among adults with chronic conditions, lower SES has been associated with longer hospital lengths of stay (LOS), higher costs of care, 12,18 and higher risk of hospital readmissions.…”