Preventable hospital stays

Preventable Hospital Stays is the hospital discharge rate for ambulatory care-sensitive conditions per 1,000 fee-for-service Medicare enrollees. Ambulatory care-sensitive conditions include: convulsions, chronic obstructive pulmonary disease, bacterial pneumonia, asthma, congestive heart failure, hypertension, angina, cellulitis, diabetes, gastroenteritis, kidney/urinary infection, and dehydration. This measure is age-adjusted.

Measure Tabs

Reason for Ranking

Hospitalization for diagnoses treatable in outpatient services suggests that the quality of care provided in the outpatient setting was less than ideal. The measure may also represent a tendency to overuse hospitals as a main source of care.

Measurement Strengths and Limitations

The rate of preventable hospital stays is often used to assess the effectiveness and accessibility of primary healthcare.[1,2] A study using data from the National Hospital Discharge Survey found that 3.1 million (12%) of all hospitalizations in 1990 were for potentially preventable conditions.[3]

A weakness of this measure is that it uses Medicare claims data, which limits the population evaluated to mostly individuals age 65 and older. This measure, therefore, may potentially miss trends and disparities among younger age groups.

This measure could be classified as both a quality and access measure, as some literature describes hospitalization rates for ambulatory care-sensitive conditions primarily as a proxy for access to primary healthcare.[4]