Better access to health prevention programs and primary healthcare could have kept thousands of California adults out ofhospitals, according to a new statewide study.
According to new data released last week by the Office ofStatewide Health Planning and Development, there were more than335,000 adult hospitalizations in California that could have beenavoided if the patient had seen a doctor sooner.
According to the state agency, so-called “preventablehospitalizations” are an indication of systemic shortcomingsrelated to access to quality primary care.
“These are people going into the hospital that probablyshouldn’t be if they were getting good primary care up front,” saidMichael Kassis, a research specialist with the office.
Poor environmental factors and a failure to follow medicaltreatment also could prompt these avoidable hospital stays, theagency said.
The latest figures are based on an analysis of 2009 hospitalinpatient discharges by state-licensed facilities of 13 “preventionquality indicators,” or readily treatable medical conditions suchas chest pains and dehydration.
There’s been a slight uptick in preventable hospitalizations inCalifornia since 2008, when there were 317,050 cases. In 1999,there were 399,113 cases.
The financial implications of these avoidable hospitalizationscan be significant. A report published last year by the Centers forMedicare & Medicaid Services noted that 26 percent of allpatients who are dually eligible for Medicare and Medicaid hadavoidable hospitalizations – at a cost of more than $7 billion totaxpayers in 2011.
California had fewer preventable hospitalizations among thispopulation than the national average, and based on the new statedata, these hospitalizations cost the California-based health caresystem an estimated $3.6 billion per year.
Although these costs are associated with patients who are bothpublicly and privately insured, the state agency said avoidablehospitalizations ultimately affect all Californians.
“Outpatient care costs less than hospital care, resulting insignificant cost savings for health plans/insurers, employers,government and the ultimate payer – all of us,” according to a 2010report on preventable hospitalizations published by the office.
The new California data is also available by county, with ruralcounties like Del Norte, Glenn and San Joaquin experiencing amongthe highest five-year averages of preventable hospitalizations forbacterial pneumonia, diabetes-related amputations and chronicobstructive pulmonary disease.
Los Angeles residents had rates of preventable hospitalizationsabove the state average for conditions such as long-termcomplications of diabetes, hypertension, congestive heart failureand adult asthma.
“The reason it’s good to have this data is that it forces us tolook upstream and understand where there are missed opportunitiesto address these events and think about how we can develop systemicapproaches to reducing them,” said Dr. Jonathan E. Fielding,director of the Los Angeles County Department of Public Health andthe county’s health officer.
Los Angeles is home to about 2.2 million uninsured non-elderlyadults and children, which Fielding said contributes to the area’spreventable hospitalizations.
“I think there needs to be more emphasis on primary care, butyou can’t emphasize that unless you have the means to access it,”he said. “In the state as a whole, and particularly in Los AngelesCounty, there are too many adults who lack health insurance anddon’t get the care they need in a timely fashion, so they result inpreventable hospitalizations. Good access to primary care can helpavert these hospitalizations.”
Among children, there were an additional 53,897 preventablehospitalizations in 2009 related to five medical conditions, suchas low birth weight and short-term complications from diabetes.Imperial County had high rates of pediatric gastroenteritis andurinary tract infections.
Jeremy Cantor of the Oakland-based Prevention Institute saidthese statistics illustrates the importance of preventivemedicine.
“All of these things are preventable to some extent, so the factthat the numbers are above zero means that there needs to be morefocus on prevention,” he said. “What this means – not just in termsof health care costs, but also productivity and days that peoplehave to take off work – has a huge impact on the state.”
But funds for health prevention recently have become morescarce. Last week, Congress passed a bill that extends the payrolltax credit and forestalls payment cuts to doctors who acceptMedicare by trimming about $5 billion from the federal Preventionand Public Health Fund over the next decade. In 2010, Californiareceived about $12 million from the fund, which was created underthe federal health reform law.
Cantor added that environmental and social factors that affecthealth can’t be overlooked.
“What can be misleading is that the implication is that theserates are determined by a patient’s experience in clinicalsettings,” he said. “That is far from the case. Part of the pictureis access to quality clinical care. But it’s also related toexposures to toxins, and economic and educational opportunities,the lack of access to places to be physically active and a wholespectrum of factors that shape health outcomes.”
The data on preventable hospitalizations is not an indication ofpoor hospital care. But the 2009 data recently released by theOffice of Statewide Health Planning and Development also examinedpatient safety and found 334 incidents in which gauze or othersurgical equipment was left inside the body during an operation and8,230 cases in which patients were accidentally cut or puncturedduring their hospital stay.
California Watch is a project of the nonprofit Center forInvestigative Reporting. Contact the author atbyeung@cironline.org. For more, visit californiawatch.org.
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