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Research ArticleOriginal Research

Potentially Preventable Hospitalizations Among Older Adults: 2010-2014

Elham Mahmoudi, Neil Kamdar, Allison Furgal, Ananda Sen, Phillip Zazove and Julie Bynum
The Annals of Family Medicine November 2020, 18 (6) 511-519; DOI: https://doi.org/10.1370/afm.2605
Elham Mahmoudi
1Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
PhD, MS
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  • For correspondence: Mahmoudi@med.umich.edu
Neil Kamdar
2Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
MA
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Allison Furgal
1Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
MS
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Ananda Sen
1Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
PhD
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Phillip Zazove
3Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
MD
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Julie Bynum
4Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
MD
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  • Figure 1.
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    Figure 1.

    Unadjusted rates of potentially preventable hospitalization: 2010-2014.

    Note: Source is Medicare claims data (2010-2014).

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    Figure 2.

    Adjusted odds ratios for factors associated with potentially preventable hospitalization: 2010-2014.

    MMC = Medicare Managed Care; PCP = primary care physician.

    Notes: Source is Medicare claims data (2010-2014). Regression results are presented in Supplemental Table 6, available at https://www.AnnFamMed.org/content/18/6/511/suppl/DC1/.

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    Figure 3.

    Adjusted predicted rates of potentially preventable hospitalization: 2010-2014.

    Notes: Source is Medicare claims data (2010-2014). Regression results are presented in Supplemental Table 6, available at https://www.AnnFamMed.org/content/18/6/511/suppl/DC1/.

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    Table 1.

    Characteristics of Patients With Potentially Preventable and Nonpreventable Hospitalizations in 2010 and 2014

    Characteristic2010 Hospitalizations (N = 1,170,242 Patients)2014 Hospitalizations (N = 818,229 Patients)
    Potentially PreventableNonpreventableP Value or Difference (95% CI)Potentially PreventableNonpreventableP Value or Difference (95% CI)
    Patients, No. (%)196,971 (16.8)973,271 (83.2)<.001128,442 (15.7)689,787 (84.3)<.001
    Age, mean (SD), y80.0 (8.3)77.6 (7.8)2.4 (2.3-2.4)80.2 (8.5)77.8 (8.1)2.5 (2.4-2.6)
    Sex, No. (%)
    Male75,237 (38.2)409,605 (42.1)<.00147,581 (37.0)288,293 (41.8)<.001
    Female121,734 (61.8)563,666 (57.9)<.00180,861 (63.00)401,494 (58.2)<.001
    Race/ethnicity, No. (%)
    Non-Hispanic White155,589 (79.0)812,528 (83.5)<.001102,973 (80.2)581,524 (84.3)<.001
    Black22,208 (11.3)80,362 (8.3)<.00113,437 (10.5)52,833 (7.7)<.001
    Hispanic13,761 (7.0)55,134 (5.7)<.0017,913 (6.2)32,808 (4.8)<.001
    Other5,219 (2.7)24,411 (2.5)<.0013,784 (3.0)19,393 (2.8)<.001
    Unknown/missing194 (0.1)836 (0.1)<.001335 (0.3)3,229 (0.5)<.001
    Medicaid, No. (%)
    No138,538 (70.3)797,885 (82.0)<.00191,324 (71.1)568,698 (82.5)<.001
    Yes58,433 (29.7)175,386 (18.0)<.00137,118 (28.9)121,089 (17.6)<.001
    ZIP code-level median income,a No. (%)
    Low54,978 (27.9)232,111 (23.9)<.00136,279 (28.3)164,625 (23.9)<.001
    Average93,791 (47.6)480,076 (49.3)<.00161,735 (48.1)339,375 (49.2)<.001
    High44,091 (22.4)242,669 (24.9)<.00127,848 (21.7)172,545 (25.0)<.001
    Missing4,111 (2.1)18,415 (1.9)<.0012,580 (2.0)13,242 (1.9)<.001
    Number of prescriptions, mean (SD)14.4 (13.7)10.4 (11.0)4.0 (3.9-4.1)17.2 (14.9)12.7 (12.2)4.6 (4.4-4.7)
    Elixhauser index, mean (SD)b9.1 (8.1)5.3 (6.9)3.8 (3.8-3.9)10.7 (8.7)6.8 (8.0)3.9 (3.9-4.0)
    County-level health resources
    PCPs per 1,000,c No. (%)
       Low12,987 (6.6)57,800 (6.0)<.0019,276 (7.2)44,487 (6.5)<.001
       Medium109,803 (55.8)532,096 (54.7)<.00171,792 (56.0)376,443 (54.7)<.001
       High73,931 (37.6)382,137 (39.3)<.00147,173 (36.8)267,854 (38.9)<.001
    MMC penetration, mean (SD), %d23.6 (14.2)24.3 (14.1)–0.7(–0.7 to –0.6)26.9 (13.7)27.9 (13.5)–0.3(–0.4 to –0.1)
    Hospitals per 100,000,e No. (%)
       Low38,533 (19.6)197,589 (20.3)<.00124,512 (19.1)139,119 (20.2)<.001
       Medium146,6 4 5 ( 74.6)729,026 (75.0)<.00194,890 (74.0)513,130 (74.5)<.001
       High11,542 (5.9)45,408 (4.7)<.0018,837 (6.9)36,527 (5.3)<.001
    • MMC = Medicare Managed Care; PCP = primary care physician.

    • Note: Based on 20% random sample of Medicare fee-for-service claims data of included cohort of older adults with at least 1 hospitalization during 2010 or 2014.

    • ↵a Low: <25th percentile; Medium: 25th-75th percentile; High: >75th percentile.

    • ↵b Possible index scores range from 0 (lower disease burden) to 31 (higher disease burden).

    • ↵c Low: <25th percentile (≤0.49 per 1,000); Medium: 25th-75th percentile (0.49-1.04 per 1,000); High: >75th percentile (>1.04 per 1,000).

    • ↵d Percentage of Medicare-eligible patients who chose a Medicare Advantage plan (as opposed to fee for service).

    • ↵e Low: <25th percentile (≤0.996 per 100,000); Medium: 25th-75th percentile (0.996-6.17 per 100,000); High: >75th percentile (>6.17 per 100,000).

Additional Files

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    Supplemental Appendix, Tables, Figures

    Files in this Data Supplement:

    • Supplemental data - App, Tables, Figures - PDF file
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The Annals of Family Medicine: 18 (6)
The Annals of Family Medicine: 18 (6)
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1 Nov 2020
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Potentially Preventable Hospitalizations Among Older Adults: 2010-2014
Elham Mahmoudi, Neil Kamdar, Allison Furgal, Ananda Sen, Phillip Zazove, Julie Bynum
The Annals of Family Medicine Nov 2020, 18 (6) 511-519; DOI: 10.1370/afm.2605

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Potentially Preventable Hospitalizations Among Older Adults: 2010-2014
Elham Mahmoudi, Neil Kamdar, Allison Furgal, Ananda Sen, Phillip Zazove, Julie Bynum
The Annals of Family Medicine Nov 2020, 18 (6) 511-519; DOI: 10.1370/afm.2605
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Subjects

  • Person groups:
    • Older adults
    • Vulnerable populations
  • Methods:
    • Quantitative methods
  • Other research types:
    • Health services
  • Core values of primary care:
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  • Other topics:
    • Disparities in health and health care

Keywords

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  • potentially preventable hospitalization
  • prevention quality indicators
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