Hospital Use Down But Avoidable Hospitalizations Increase
Hospitalizations that might have been avoided if patients had received timely and effective ambulatory care increased by two thirds from 1980-98 according to results from the Centers for Disease Control and Prevention's National Health Care Survey, published in the March-April 2001 issue of Health Affairs.
The number of hospitalizations for avoidable conditions rose from 2.2 million in 1980 to 3.7 million in 1988–from 5.9 percent to 11.5 of all hospitalizations. Avoidable conditions, as determined by a panel of physicians, are those for which timely and appropriate ambulatory care should prevent the illness, control an acute episode or manage a chronic condition so that hospitalization is generally unnecessary. However, the study recognized that not all hospitalizations for each condition, depending upon severity of the condition and other factors, could be avoided.
Hospitalization rates increased for pneumonia, congestive heart failure, and cellulitis. In addition, the survey indicated that hospitalization rates were also up for ruptured appendix and potassium deficiency. However, rates were down for asthma, perforated or bleeding ulcer and inflammation of the kidney.
Over the past two decades, avoidable hospitalizations increased substantially for older Americans. For those under age sixty-five avoidable hospitalizations declined for white patients, but were up among black patients.
Regardless of source of payment–Medicaid, Medicare, private insurance or self-pay–avoidable hospitalizations increased from 1980 to 1998. The highest level for hospitalizations (one in five) was for those 65 and over with Medicare and Medicaid shown as the source of payment.
"Trends in Avoidable Hospitalization, 1980-1988," is based on data from the National Hospital Discharge Survey, one of the components of CDC's National Health Care Survey. Other components of the health care survey obtain data from surveys of ambulatory care provided in physicians' offices, hospital emergency and outpatient departments; nursing homes; and hospice and home health agencies.
"Trend Data on Medical Encounters: Tracking a Moving Target" uses the full range of health care data to examine how medical care use has changed over the past fifteen years. Since 1985, the general trends indicate that hospital discharge rates decreased–down about 20 percent. However, nursing home discharge rates rose more than any other segment of medical care, reflecting the aging of the U.S. population. Between 1992 and 1996, home health care expanded rapidly, but declined in 1998. The number of agencies providing home and hospice care services doubled between 1992 and 1998.
The analysis shows little change in the rate of visits to physicians, but there were notable changes in the content of the visit. Patients were more likely to have medicines prescribed, continued or provided during their visits. There were increases in the prescribing of antidepressants and the study also showed a drop in the use of antibiotics for children.
Nursing home residents in 1997 were more disabled and received more services than they did in 1985. This may reflect the availability of alternative services such as home health care which allows people to postpone or avoid a nursing home.
For more information on the National Health Care Survey, conducted by CDC's National Center for Health Statistics and access to current and trend data, check the CDC website at http://www.cdc.gov/nchs.
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