Preventable Hospitalizations: Does Rurality or Non-Physician Clinician Supply Matter?

Abstract

This study examines the relationship between rurality as well as the proportion of non-physician clinicians and county rates of ambulatory care sensitive hospitalizations (ACSHs) for pediatric, adult and elderly populations in Nebraska. The study design was a cross-sectional observational study of county level factors that affect the county level rates of ACSHs using Poisson regression models. Rural (non-metro) counties have significantly higher ACSHs for both pediatric and adult population, but not for the elderly. Frontier counties have significantly higher adult ACSHs. The proportion of primary care providers who are non-physician clinicians does not have a significant association with ACSHs for any of the age groups. The results indicate that rurality may have a greater impact on pediatric and adult ACSHs and the proportion of NPCs in the primary care provider workforce does not significantly impact ACSH rates.

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

“…Unlike previous studies, 5,29 living in a rural county decreased the odds that an admission was potentially preventable for all diagnoses except diabetes. In addition, low income as measured according to residence in a zip code with low median income increased the odds of potentially preventable admission for UTI and asthma, as similarly reported in previous pediatric research 5,6 (particularly on asthma 30 ) and in adults. 23 For patients with comorbid illness, admissions had lower odds of being potentially preventable.…”

“…Although we attempted to control for hospital and local factors such as hospital size and rural location, there are likely other explanatory factors that were not available in the Texas or American Hospital Association administrative files. Finally, the AHRQ system is one of several potentially preventable algorithms that exist and have been used in the past, [2][3][4][5][6][7][8] and there is likely disagreement about whether all of the AHRQ conditions coded are truly preventable and whether it represents an all-inclusive list of preventable admissions. Nevertheless, the AHRQ has set a national standard, and the data originate from a large population over several years and provide new information on factors that should be targeted in efforts to reduce potentially preventable pediatric admissions.…”

“…2 A better understanding of the factors associated with preventable admissions is needed to generate targeted solutions to improve the value and quality of care delivered. Previous research on preventable admissions in pediatrics has used a variety of definitions for "preventable," including the Billings algorithm, 3 physician or researcher opinion, 4,5 or various single previous studies, 2,[6][7][8] thus decreasing the generalizability of the findings.…”

Risco de interpretação falaciosa das internações por condições sensíveis à atenção primária em contextos locais, Itaboraí, Rio de Janeiro, Brasil, 2006-2011

“…In order to better understand admissions for PCSCs, Brazilian and international studies have frequently focused on their characterization and the identification of associated socio-demographic and healthcare-related variables 3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18 . Brazil has also seen analytical ecological studies that have associated the decline in admissions for PCSCs with the expansion of primary care by the Family Health Strategy (FHS) 19,20 , as well as descriptive studies on the correlation between the decline in the rates or proportions of admissions for PCSCs and the strategy's expansion in more limited geographic areas 21,22,23 .…”

Preventable Hospitalization Rates and Neighborhood Poverty among New York City Residents, 2008–2013

“…4 A relationship between provider supply and preventable hospitalizations has also been found although the relationship with supply is not consistent. 4,[9][10][11][12][13] For example, not every study finds that low provider supply is a significant predictor of preventable hospitalizations. Additionally, Black race and Hispanic ethnicity 8,[14][15][16] have been associated with higher rates of preventable hospitalizations.…”