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Adult Potentially Preventable Hospitalizations in Texas 2014 Crossroads Conference: Navigating Health Care in West Texas June 5, 2014 Mike Gilliam, Jr.,

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Presentation on theme: "Adult Potentially Preventable Hospitalizations in Texas 2014 Crossroads Conference: Navigating Health Care in West Texas June 5, 2014 Mike Gilliam, Jr.,"— Presentation transcript:

1 Adult Potentially Preventable Hospitalizations in Texas 2014 Crossroads Conference: Navigating Health Care in West Texas June 5, 2014 Mike Gilliam, Jr., M.S.W., M.P.H. Assessment & Benchmarking Specialist Texas Department of State Health Services (DSHS)

2 Page 2 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Since 2008, DSHS has educated communities and policymakers on the impact of these ten adult potentially preventable hospitalization conditions: 1. Bacterial Pneumonia; 2. Dehydration; 3. Urinary Tract Infection (UTI); 4. Angina (without procedures); 5. Congestive Heart Failure (CHF); 6. Hypertension; 7. Asthma; 8. Chronic Obstructive Pulmonary Disease (COPD); 9. Diabetes Short-term (ST) Complications; and 10. Diabetes Long-term (LT) Complications. Adult hospitalizations for these conditions are considered “potentially preventable,” because if the individual had access to and cooperated with appropriate outpatient healthcare, the hospitalization would likely not have occurred.

3 Page 3 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Bacterial Pneumonia is a serious inflammation of the lungs caused by an infection. Bacterial pneumonia primarily impacts older adults. Communities can potentially prevent hospitalizations by encouraging older adults and other high risk individuals to get vaccinated for bacterial pneumonia. Dehydration means the body does not have enough fluid to function well. Dehydration primarily impacts older adults or institutionalized individuals who have a limited ability to communicate thirst. Communities can potentially prevent hospitalizations by encouraging attention to the fluid status of individuals at risk. UTI is usually caused when bacteria enter the bladder and cause inflammation and infection. It is a common condition, with older adults at highest risk. In most cases, an uncomplicated UTI can be treated with proper antibiotics. Communities can potentially prevent hospitalizations by encouraging individuals to practice good personal hygiene; drink plenty of fluids; and (if practical) avoid conducting urine cultures in asymptomatic patients who have indwelling urethral catheters. Angina (without procedures) is chest pain that occurs when a blockage of a coronary artery prevents sufficient oxygen-rich blood from reaching the heart muscle. Communities can potentially prevent hospitalizations by encouraging regular physical activity; smoking cessation; controlling diabetes, high blood pressure, and abnormal cholesterol; maintaining appropriate body weight; and daily administration of an anti-platelet medication (like low dose aspirin) in most individuals with known coronary artery disease. CHF is the inability of the heart muscle to function well enough to meet the demands of the rest of the body. Communities can potentially prevent hospitalizations by encouraging individuals to reduce risk factors such as coronary artery disease, diabetes, high cholesterol, high blood pressure, smoking, alcohol abuse, and use of illegal drugs.

4 Page 4 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Hypertension is a syndrome with multiple causes. Hypertension is often controllable with medications. Communities can potentially prevent hospitalizations by encouraging an increased level of aerobic physical activity, maintaining a healthy weight, limiting the consumption of alcohol to moderate levels for those who drink, reducing salt and sodium intake, and eating a reduced-fat diet high in fruits, vegetables, and low-fat dairy food. Asthma occurs when air passages of the lungs become inflamed and narrowed and breathing becomes difficult. Asthma is treatable, and most flare-ups and deaths can be prevented through the use of medications. Communities can potentially prevent hospitalizations by encouraging people to learn how to recognize particular warning signs of asthma attacks. Treating symptoms early can result in prevented or less severe attacks. COPD is characterized by decreased flow in the airways of the lungs. It consists of three related diseases: asthma, chronic bronchitis and emphysema. Because existing medications cannot change the progressive decline in lung function, the goal of medications is to lessen symptoms and/or decrease complications. Communities can potentially prevent hospitalizations by encouraging education on smoking cessation and minimizing shortness of breath. Diabetes ST Complications are extreme fluctuations in blood sugar levels. Extreme dizziness and fainting can indicate hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), and if not brought under control, seizures, shock or coma can occur. Diabetics need to monitor their blood sugar levels carefully and adjust their diet and/or medications accordingly. Communities can potentially prevent hospitalizations by encouraging the regular monitoring and managing of diabetes in the outpatient health care setting and encouraging patient compliance with treatment plans. Diabetes LT Complications include risk of developing damage to the eyes, kidneys and nerves. Risk also includes developing cardiovascular disease, including coronary heart disease, stroke, and peripheral vascular disease. Long-term diabetes complications are thought to result from long-term poor control of diabetes. Communities can potentially prevent hospitalizations by encouraging the regular monitoring and managing of diabetes in the outpatient health care setting and encouraging patient compliance with treatment plans.

5 Page 5 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Methodology to identify “Potentially Preventable Hospitalizations” was developed by the Agency for Healthcare Research and Quality (AHRQ). AHRQ is the lead federal agency responsible for research on healthcare quality costs, outcomes and patient safety. Potentially Preventable Hospitalizations are also referred to as Ambulatory Sensitive Conditions, Prevention Quality Indicators and/or Potentially Preventable Admissions/Events. Potentially Preventable Hospitalization data is based on primary diagnosis. Potentially Preventable Hospitalization data is based on county of residence – not the county where the individual was hospitalized.

6 Page 6 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) The purpose of this information is to assist in improving healthcare and reducing healthcare costs. This information is not an evaluation of hospitals or other healthcare providers. This information can be used as a tool to assess a community’s outpatient healthcare system. Inpatient hospital data in Texas is available from the Texas Health Care Information Collection (www.dshs.state.tx.us/thcic), in the Center for Health Statistics, at DSHS.

7 Page 7 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) *From 2007-2012, adult residents of Texas received approximately $47.4 Billion (B) in charges for 1,459,249 hospitalizations that were potentially preventable. *$47.4 B equals $2,483 for every adult Texan. *Allocation of the $47.4 B by Expected Primary Source of Payment:...Medicare $30.0 B(63.3%) …Private Health Insurance $ 8.5 B(18.0%) …Uninsured $ 4.6 B(09.7%) …Medicaid $ 3.2 B(06.8%) …Other $ 1.1 B(02.2%) *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

8 Page 8 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) *Number of Hospitalizations: 1,459,249 *Average Hospital Charge:$32,464 *Average Length of Hospital Stay:4.9 Days *Average Age of Individual Hospitalized:63 Years *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

9 Page 9 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents of Texas (2007-2012) Bacterial Pneumonia Dehydration UTI Angina w/o procedures CHF Hyper- tension COPD or Older Adult Asthma Diabetes ST Diabetes LT Hospitalizations293,85794,531205,31815,762338,49765,962252,77759,617132,928 Female55.8%62.4%74.6%55.2%51.6%62.8%62.4%51.7%47.1% Male44.2%37.6%25.4%44.8%48.4%37.2%37.6%48.3%52.9% White72.6%71.3%69.0%66.4%63.7%49.8%74.2%53.6%53.4% Black10.2%11.3%10.9%14.0%18.4%31.1%13.0%25.2%19.4% Other (Race)17.0% 19.8%18.5%17.6%18.9%12.5%21.1%27.0% Hispanic19.1%19.9%24.3%23.4%21.6%23.4%13.8%26.7%36.0% Texas (U.S. Census 2010, Adult Population) White (Race): 72.2% Black (Race): 11.6% Other (Race): 16.2% Hispanic (Ethnicity): 33.6% *Values of less than 3% are included in “Other”

10 Page 10 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents of Texas (2007-2012) Bacterial Pneumonia Dehydration UTI Angina w/o Procedures CHF Hyper- Tension COPD or Older Adult Asthma Diabetes ST Diabetes LT Hospitalizations 293,85794,531205,31815,762338,49765,962252,77759,617132,928 Average Age65 Years 64 Years 65 Years 58 Years 68 Years 58 Years 67 Years 38 Years 57 Years Age 18-19 Years6.5% 20-29 Years6.2%24.2% 30-39 Years3.2%6.2%4.8%19.4%7.9% 40-49 Years8.1%8.8%7.3%16.6%3.6%16.8%9.5%19.8%16.2% 50-59 Years13.6%13.4%9.7%26.8%13.2%21.4%19.0%16.0%24.6% 60-69 Years17.4%16.5%12.9%23.0%20.2%18.3%26.0%8.1%22.3% 70-79 Years22.1%20.9%20.2%16.5%25.0%16.8%26.8%15.9% 80-89 Years23.1%21.7%26.7%10.0%25.8%13.7%16.2%9.0% 90+ Years7.6%6.9%9.4%7.7%3.1% Other8.3%8.7%1.3%7.1%4.5%5.1%2.5%6.0%4.2% *Values of less than 3% are included in “Other”

11 Page 11 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents of Texas (2007-2012) Bacterial Pneumonia Dehydration UTI Angina w/o procedures CHF Hyper – Tension COPD or Older Adult Asthma Diabetes ST Diabetes LT Hospitalizations 293,85794,531205,31815,762338,49765,962252,77759,617132,928 Discharged to Home/Self-Care 61.6%68.2%57.8%77.0%59.9%84.2%71.8%86.3%59.8% Skilled Nursing Facility 11.5%10.7%17.8%10.4%3.5%6.7%8.7% Home Health 10.7%9.6%11.6%3.1%14.7%6.7%11.5%4.3%16.4% Intermediate Care Facility 3.9% ST Hospital 12.5% Medicare Certified LT Hospital 5.9% Left Against Medical Advice 3.5% Died 3.3% Other 12.7%11.2%8.8%7.1%14.7%5.2%9.8%5.7%9.0% *Values of less than 3% are included in “Other”

12 Page 12 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents of Texas (2007-2012) Bacterial Pneumonia Dehydration UTI Angina w/o procedures CHF Hyper – tension COPD or Older Adult Asthma Diabetes ST Diabetes LT Hospitalizations 293,85794,531205,31815,762338,49765,962252,77759,617132,928 Expected Primary Source of Payment Medicare 65.1%61.5%66.2%45.0%73.5%46.2%66.8%20.0%53.5% Private Health Insurance 19.6%24.8%16.2%32.5%12.0%25.1%16.6%29.1%20.4% Uninsured 8.0%6.6%9.2%12.4%6.9%18.2%7.3%32.1%13.2% Medicaid 5.4%5.0%6.4%6.1%5.9%7.2% 13.9%10.0% Other 1.9%2.1%1.9%4.1%1.7%3.2%2.1%4.9%2.9% Avg. Length of Hospital Stay 5.4 days3.6 days4.3 days2.3 days5.3 days3.2 days4.6 days3.7 days6.7 days Avg. Hospital Charge $34,736$19,984$23,880$22,962$40,252$23,952$29,738$25,275$43,505 Total Approximate Hospital Charges $10.2 B$1.9 B$4.9 B$361.9 M$13.6 B$1.6 B$7.5 B$1.5 B$5.8 B *Values of less than 3% are included in “Other” B means Billion M means Million

13 Page 13 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Combined, Bacterial Pneumonia and CHF comprise: *43.3% (632,354) of admissions for Potentially Preventable Hospitalizations; and *50.2% ($23.8 B) of charges for Potentially Preventable Hospitalizations. *Combination of ten adult potentially preventable hospitalization conditions (2007-2012).

14 Page 14 Adult Potentially Preventable Hospitalizations in Texas Adult Residents of Texas (2006-2010) Bacterial Pneumonia DehydrationUTIAngina w/o procedures CHFHyper- Tension AsthmaCOPDDiabetes ST Diabetes LT Hospitalizations 250,72168,557160,59914,984296,95351,81777,900145,20045,192108,078 *Mental Illness/ Substance Abuse (Secondary Diagnosis) *32.5%*31.0%*36.1%*31.3%*20.6%*30.9%*37.0%*44.4%*29.3%*20.3% *Alcohol and other Drug Diagnoses (Excluding Tobacco Use Disorder) are Significantly Underrepresented Due to Data Suppression Requirements. Secondary Diagnosis of Mental Illness/Substance Abuse in Adult Potentially Preventable Hospitalizations in Texas (2006-2010) For example, 32.5% of the 250,721 adult potentially preventable hospitalizations for Bacterial Pneumonia (2006-2010) had a secondary diagnosis of mental illness/substance abuse.

15 Page 15 Adult Potentially Preventable Hospitalizations in Texas (2007-2012)

16 Page 16 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) In-depth data profiles are available with the following information:  Years (2007-2012);  Condition (Ten Conditions);  County;  Age Group;  Sex;  Race;  Ethnicity;  Zip Code of Residence;  Hospitalized at;  Average Length of Hospital Stay;  Average Hospital Charge;  Total Hospital Charges;  Discharged to; and  Expected Primary Source of Payment. To request an in-depth profile, send an email to mike.gilliam@dshs.state.tx.us.

17 Page 17 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) LUBBOCK COUNTY: Adult Residents Diabetes Short-term Complications Potentially Preventable Hospitalizations (2007-2012) Total Hospitalizations1,133 AgeZip Code of Residence 18-19 Years04.2%7940313.2% 20-29 Years32.4%7941609.5% 30-39 Years19.8%7942307.8% 40-49 Years16.4%7941107.8% 50-59 Years12.8%7941507.7% 60-69 Years08.5%7940707.6% Other05.9%7941207.1% 7941306.5% Female49.4% 7942406.2% Male50.6%7941405.6% 7940405.6% White (Race)70.7%7940105.6% Black (Race)*19.4%Other03.6% Other (Race)09.9% Hispanic (Ethnicity)*39.3%*The adult (18+) population of Lubbock County is approximately 09.0% Black and 28.6% Hispanic. Example of In-Depth Data Profile:

18 Page 18 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) LUBBOCK COUNTY: Adult Residents Diabetes Short-term Complications Potentially Preventable Hospitalizations (2007-2012) Total Hospitalizations1,133 Place of HospitalizationsExpected Primary Source of Payment University Medical Center68.0%Medicaid17.9% Covenant Medical Center26.3%Medicare22.7% Other05.8%Private Health Insurance23.7% Uninsured32.5% Average Length of Stay4.3 DaysOther03.2% Average Hospital Charge$26,694 Total Hospital Charges$30,244,581 Discharged to Home/Self Care87.0% Home Health05.2% Skilled Nursing Facility03.1% Other04.2% Example of In-Depth Data Profile:

19 Page 19 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Efforts to Reduce Adult Potentially Preventable Hospitalizations The 82nd Texas Legislature appropriated $2 M for DSHS to implement the Reducing Adult Potentially Preventable Hospitalizations Initiative in FY 12/13. DSHS contracted with 16 counties to implement evidence-based interventions, through a community coordinated approach, to reduce hospitalizations and/or hospital charges among adult county residents for selected potentially preventable hospitalization conditions. Adult residents in each of the 16 counties had a hospitalization rate more than 50% higher than the state rate from 2005-2009. Each of the 16 counties had a Project Contact that coordinates monthly coalition meetings to maximize implementation of one or more of the following evidence-based interventions: immunizations; patient education; community education; smoking cessation; healthcare provider education; diabetes self-management education; patient case management; nutrition & physical activity; weight management; glycemic control; and blood pressure control.

20 Page 20 Adult Potentially Preventable Hospitalizations in Texas (2007-2012)

21 Page 21 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) CountyHospitalization Condition(s)Project ContactEmail AngelinaBacterial Pneumonia, Dehydration & UTISharon Shaw (Angelina Co. & Cities Health District)sshaw@acchd.us BrooksBacterial PneumoniaDiana Bill (Community Action Corp. of S TX)diana.bill@cacost.org EctorAsthma & COPDSherrill Rhodes (Medical Ctr. Health System)srhodes@echd.org GraysonBacterial Pneumonia, Dehydration & UTIJohn Teel (Grayson Co. Health Dept.)teelj@co.grayson.tx.us HuntBacterial Pneumonia & COPDPam Andrews (Hunt Co. Health Dept.)pandrews@huntcounty.net LibertyBacterial Pneumonia, CHF & COPDSteven Racciato (Health Ctr. of SE TX)fqhc1@sbcglobal.net LimestoneBacterial Pneumonia & CHFKimberly Meyer (Limestone Medical Ctr.)kmeyer@lmchospital.com NacogdochesDehydration & UTIKinnie Douglas (Nacogdoches Memorial Hospital)douglask@nacmem.org OrangeBacterial Pneumonia, CHF & COPDJarren Garrett (Baptist Hospitals of SE TX – Orange)jarren.garrett@bhset.net PolkBacterial Pneumonia, CHF & COPDJerry Hathorn (Polk Co. Health Advisory Coalition)jerry.hathorn@dshs.state.tx.us Red RiverCHF & COPDMarleah Drew (Lennox Health Resources)mdlennoxhrc@cebridge.net San AugustineBacterial PneumoniaSharon Shaw (Angelina Co. & Cities Health District)sshaw@acchd.us Tom GreenBacterial Pneumonia, UTI & COPDDianna Spieker (Tom Green Co.)dianna.spieker@co.tom-green.tx.us TrinityBacterial Pneumonia, UTI & COPDCarl Dyer (Trinity Co.)carl.dyer@co.trinity.tx.us VictoriaBacterial Pneumonia, CHF & DiabetesRobbyn Michalka (Texas AHEC East – Victoria Region) robbyn.michalka@victoriacollege.edu WalkerHypertension & DiabetesMeredith Henry (Texas AgriLife – Walker Co.)mdhenry@ag.tamu.edu FY12/13 Reducing Adult Potentially Preventable Hospitalizations Initiative (01/01/12 – 08/31/13)

22 Page 22 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) CountyHospitalization Condition(s)Project ContactEmail AngelinaBacterial Pneumonia, Dehydration, UTI & Hypertension Ann Watson (Angelina Co. & Cities Health District)awatson@acchd.us BrooksBacterial Pneumonia & DehydrationDiana Bill (Community Action Corp. of S TX)diana.bill@cacost.org EctorAsthma, COPD & DiabetesDianna Ruiz (Medical Ctr. Health System)dhuerta@echd.org GraysonBacterial Pneumonia, Dehydration, UTI & COPD Sandra Clark (Grayson Co. Health Dept.)sandrac@co.grayson.tx.us LimestoneBacterial Pneumonia, CHF & COPDKimberly Meyer (Limestone Medical Ctr.)kmeyer@lmchospital.com OrangeBacterial Pneumonia, Angina, CHF & COPD Jarren Garrett (Baptist Hospitals of SE TX – Orange)jarren.garrett@bhset.net PolkBacterial Pneumonia, Dehydration, CHF & COPD Jerry Hathorn (Polk Co. Health Advisory Coalition)jerry.hathorn@dshs.state.tx.us Red RiverCHF, COPD & DiabetesTammy Lawing (Lennox Health Resources)tglawing@etmc.org San AugustineBacterial Pneumonia & HypertensionAnn Watson (Angelina Co. & Cities Health District)awatson@acchd.us Tom GreenBacterial Pneumonia, Dehydration, UTI & COPD Dianna Spieker (Tom Green Co.)dianna.spieker@co.tom-green.tx.us TrinityBacterial Pneumonia, UTI, Hypertension & COPD Carl Dyer (Trinity Co.)carl.dyer@co.trinity.tx.us VictoriaBacterial Pneumonia, Angina, CHF & Diabetes Robbyn Michalka (Texas AHEC East – Victoria Region) robbyn.michalka@victoriacollege.edu WalkerHypertension, Asthma & DiabetesMeredith Henry (Texas AgriLife – Walker Co.)mdhenry@ag.tamu.edu FY14/15 Reducing Adult Potentially Preventable Hospitalizations Initiative (09/01/13 – 08/31/15) DSHS re-contracted with 13 of the 16 counties funded in FY12/13.

23 Page 23 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents of Texas (2006-2011) Bacterial Pneumonia DehydrationUTIAngina w/o procedures CHFHyper- Tension Asthma in *Younger Adults COPD or Asthma in **Older Adults Diabetes ST Diabetes LT Risk-Adjusted Rate Per 100,000 2011297.585.5199.115.8307.051.530.1366.046.1107.3 2010326.995.7208.418.4337.056.337.9418.942.8106.7 2009344.7112.0206.024.1353.555.640.5432.541.0104.8 2008360.8137.2196.226.7366.653.931.0462.239.5110.2 2007408.6152.8206.532.4424.658.636.5414.037.8110.2 2006408.8162.3214.742.4469.656.441.9420.336.0122.8 *18-39 Years of Age **40+ Years of Age TRENDS: Adult Potentially Preventable Hospitalizations Note: AHRQ recently released new methodology that separates Asthma Potentially Preventable Hospitalizations into two conditions: Asthma in *Younger Adults and COPD or Asthma in **Older Adults. The table above reflects this new methodology.

24 Page 24 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Discharge Rate for Medicare Population: Diagnoses Amenable to Non-Hospital Based-Care TexasU.S. Number per 1,000 Medicare Enrollees 2013 Report (2011 data)67.964.9 2012 Report (2010 data)72.366.6 2011 Report (2009 data)72.868.2 2010 Report (2008 data)78.770.6 2009 Report (2007 data)81.274.2 2008 Report (2006 data)87.678.4 2007 Report (2005 data)87.678.4 2006 Report (2004 data)87.677.0 Source: America’s Health Rankings – United Health Foundation  Comparing the 2013 Report to the 2010 Report, the discharge rate in Texas decreased 13.7%, as compared to the discharge rate in the U.S. which decreased 8.1%. TRENDS: Adult Potentially Preventable Hospitalizations

25 Page 25 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Adult Residents Overall Prevention Quality Indicator (PQI) Rate Freestone County Red River County TEXAS Risk-Adjusted Rate Per 100,000 20111,974.94,451.51,357.7 20082,712.86,051.71,596.9 TRENDS: Adult Potentially Preventable Hospitalizations Overall PQI Rate is an AHRQ aggregate calculation of all adult potentially preventable hospitalizations. Under the leadership of the county judge in 2008, community health coalitions in Freestone and Red River County worked with DSHS to use the potentially preventable hospitalization data to attempt to reduce adult potentially preventable hospitalizations. For example, both counties implemented vaccine outreach campaigns targeting Bacterial Pneumonia. From 2008 to 2011, the overall PQI rate for adult residents of: o Freestone County decreased 27.2%; o Red River County decreased 26.4%; and o Texas decreased 15.0%.

26 Page 26 Adult Potentially Preventable Hospitalizations in Texas (2007-2012) Project Website (www.dshs.state.tx.us/ph) State Profile; Profiles on all 254 counties in Texas; Clinical Interventions; Maps illustrating the impact of potentially preventable hospitalization conditions in Texas counties; and Funded Counties (Reducing Adult Potentially Preventable Hospitalizations Initiative). Contact Information: Mike Gilliam, Jr. (512)776-2708 mike.gilliam@dshs.state.tx.us


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