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Association Of A Regional Health Improvement Collaborative With Ambulatory Care-Sensitive Hospitalizations.

ABSTRACT: Although regional health improvement collaboratives have been adopted nationwide to improve primary care quality, their effects on avoidable hospitalizations and costs remain unclear. We quantified the association of the Better Health Partnership, a primary care-led regional health improvement collaborative operating in Cuyahoga County, Ohio (Cleveland and surrounding suburbs), with hospitalization rates for ambulatory care-sensitive conditions. The partnership uses a positive deviance approach to identify, disseminate publicly, and accelerate adoption of best practices for care of patients with diabetes, heart failure, and hypertension. Using a difference-in-differences approach, we compared rates of hospitalizations for ambulatory care-sensitive conditions in six Ohio counties before (2003-08) and after (2009-14) the establishment of the partnership. Age- and sex-adjusted hospitalization rates for targeted ambulatory care-sensitive conditions in Cuyahoga County declined significantly more than the rates in the comparator counties in 2009-11 (106 fewer hospitalizations per 100,000 adult residents) and 2012-14 (91 fewer hospitalizations). We estimated that 5,746 hospitalizations for ambulatory care-sensitive conditions were averted in 2009-14, leading to cost savings of nearly $40 million.

SUBMITTER: Tanenbaum J

PROVIDER: S-EPMC7003658 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Association Of A Regional Health Improvement Collaborative With Ambulatory Care-Sensitive Hospitalizations.

Tanenbaum Joseph J Cebul Randall D RD Votruba Mark M Einstadter Douglas D

Health affairs (Project Hope) 20180201 2

Although regional health improvement collaboratives have been adopted nationwide to improve primary care quality, their effects on avoidable hospitalizations and costs remain unclear. We quantified the association of the Better Health Partnership, a primary care-led regional health improvement collaborative operating in Cuyahoga County, Ohio (Cleveland and surrounding suburbs), with hospitalization rates for ambulatory care-sensitive conditions. The partnership uses a positive deviance approach ...[more]

PMID: 29401005

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Project description:ImportanceThe association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors.ObjectiveTo describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021).Design, setting, and participantsThis cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period.ExposureCOVID-19 pandemic (March 2020 to February 2021).Main outcomes and measuresAdjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence.ResultsThe study population included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6 547 231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33).Conclusions and relevanceIn this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.

Project description:BackgroundHospitalizations for ambulatory care-sensitive conditions (ACSCs), conditions that should not require inpatient treatment if timely and appropriate ambulatory care is provided, may be an important contributor to rising healthcare costs and public health burden.ObjectiveTo examine if probable major depression is independently associated with hospitalization for an ACSC in patients with diabetes.DesignSecondary analysis of data from a prospective cohort study.ParticipantsPopulation-based cohort of 4,128 patients with diabetes ≥ 18 years old seen in primary care, who were enrolled between 2000 and 2002 and followed for 5 years (through 2007).Main measuresDepressive symptoms were assessed with the Patient Health Questionnaire-9. Outcomes of interest included time to initial hospitalization for an ACSC and total number of ACSC-related hospitalizations. We used Cox proportional hazards regression models to ascertain an association between probable major depression and time to ACSC-related hospitalization, as well as Poisson regression for models examining probable major depression and number of ACSC-related hospitalizations.Key resultsPatients' mean age at study enrollment was 63.4 years (Standard Deviation: 13.4 years). Over the 5-year follow-up period, 981 patients in the study were hospitalized a total of 1,721 times for an ACSC, comprising 45.1 % of all hospitalizations. After adjusting for baseline demographic, clinical and health-risk behavioral factors, probable major depression was associated with initial ACSC-related hospitalization (Hazard Ratio: 1.41, 95 % Confidence Interval [95 % CI]: 1.15, 1.72) and number of ACSC-related hospitalizations (Relative Risk: 1.37, 95 % CI: 1.12, 1.68).ConclusionsProbable major depression in patients with diabetes is independently associated with hospitalization for an ACSC. Additional research is warranted to ascertain if effective interventions for depression in patients with diabetes could reduce the risk of hospitalizations for ACSCs and their associated adverse outcomes.

Project description:Importance:The American College of Surgeons Trauma Quality Improvement Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma Quality Improvement Program (MTQIP) goes beyond the provision of feedback alone, focusing on collaborative quality improvement. It is unknown whether the addition of a collaborative approach to benchmark reporting improves outcomes. Objective:To evaluate the association of hospital participation in the ACS TQIP (benchmark reporting) or the MTQIP (benchmark reporting and collaborative quality improvement) with outcomes compared with control hospitals that did not participate in either program. Design, Setting, and Participants:In this cohort study, data from the National Trauma Data Bank from 2009 to 2015 were used. A total of 2?373?130 trauma patients 16 years or older with an Injury Severity Score of 5 or more were identified from 98 ACS TQIP hospitals, 23 MTQIP hospitals, and 429 nonparticipating hospitals, based on program participation status in 2011. A difference-in-differences analytic approach was used to evaluate whether hospital participation in the ACS TQIP or the MTQIP was associated with improved outcomes compared with nonparticipation in a quality improvement program. Exposures:Hospital participation in MTQIP, a quality improvement collaborative, compared with ACS TQIP participation and nonparticipating hospitals. Main Outcomes and Measures:In-hospital mortality, mortality or hospice, major complications, and venous thromboembolism events were assessed. Results:Of the 2 373 130 included trauma patients, 64.2% were men and 73.0% were white, and the mean (SD) age was 50.7 (21.9) years. After accounting for patient factors and preexisting time trends toward improved outcomes, there was a statistically significant improvement in major complications after (vs before) hospital enrollment in the MTQIP collaborative compared with nonparticipating hospitals (odds ratio [OR], 0.89; 95% CI, 0.83-0.95) or ACS TQIP hospitals (OR, 0.88; 95% CI, 0.82-0.94). A similar result was observed for venous thromboembolism (MTQIP vs nonparticipating: OR, 0.78; 95% CI, 0.69-0.88; MTQIP vs ACS TQIP: OR, 0.84; 95% CI, 0.74-0.95), for which MTQIP targeted specific performance improvement efforts. Hospital participation in both ACS TQIP and MTQIP was associated with improvement in mortality or hospice (ACS TQIP vs nonparticipating: OR, 0.90; 95% CI, 0.87-0.93; MTQIP vs nonparticipating: OR, 0.88; 95% CI, 0.81-0.96). Hospitals participating in MTQIP achieved the lowest overall risk-adjusted mortality in the postenrollment period (4.2%; 95% CI, 4.1-4.3). Conclusions and Relevance:This study demonstrates that hospital participation in a regional collaborative quality improvement program is associated with improved patient outcomes beyond benchmark reporting alone while promoting compliance with processes of care.

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Association Of A Regional Health Improvement Collaborative With Ambulatory Care-Sensitive Hospitalizations.

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Association Of A Regional Health Improvement Collaborative With Ambulatory Care-Sensitive Hospitalizations.

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