TY - JOUR
T1 - Ambulatory Care Sensitive Hospitalizations among Medicaid Beneficiaries with Chronic Conditions
AU - Chopra, Ishveen
AU - Wilkins, Tricia Lee
AU - Sambamoorthi, Usha
PY - 2016
Y1 - 2016
N2 - OBJECTIVES: This study examined the relationship between ambulatory care sensitive hospitalizations (ACSH) and patient-level and county-level variables.METHODS: Utilizing a retrospective cohort approach, multi-state Medicaid claims data from 2007-2008 was used to examine ACSH at baseline and follow-up periods. The study cohort consisted of adult, non-elderly Medicaid beneficiaries with chronic physical conditions, who were continuously enrolled in fee-for-service programs, not enrolled in Medicare, and did not die during the study period (N=7,021). The dependent variable, ACSH, was calculated in the follow-up year using an algorithm from the Agency for Healthcare Research and Quality algorithm. Patient-level (demographic, health status, continuity of care) and county-level (density of healthcare providers and facilities, socio-economic characteristics, local economic conditions) factors were included as independent variables. Multivariable logistic regression models were used to examine the relationship between ACSH and independent variables.RESULTS: In this study population, 8.2% had an ACSH. African-Americans were more likely to have an ACSH [AOR=1.55, 95% CI 1.16, 2.07] than Caucasians. Adults with schizophrenia were more likely to have an ACSH, compared to those without schizophrenia [AOR=1.54, 95% CI 1.16, 2.04]. Residents in counties with a higher number of community mental health centers [AOR=0.88, 95% CI 0.80, 0.97] and rural health centers [AOR=0.98, 95% CI 0.95, 0.99] were less likely to have an ASCH.CONCLUSIONS: Programs and interventions designed to reduce the risk of ACSH may be needed to target specific population subgroups and improve healthcare infrastructure.
AB - OBJECTIVES: This study examined the relationship between ambulatory care sensitive hospitalizations (ACSH) and patient-level and county-level variables.METHODS: Utilizing a retrospective cohort approach, multi-state Medicaid claims data from 2007-2008 was used to examine ACSH at baseline and follow-up periods. The study cohort consisted of adult, non-elderly Medicaid beneficiaries with chronic physical conditions, who were continuously enrolled in fee-for-service programs, not enrolled in Medicare, and did not die during the study period (N=7,021). The dependent variable, ACSH, was calculated in the follow-up year using an algorithm from the Agency for Healthcare Research and Quality algorithm. Patient-level (demographic, health status, continuity of care) and county-level (density of healthcare providers and facilities, socio-economic characteristics, local economic conditions) factors were included as independent variables. Multivariable logistic regression models were used to examine the relationship between ACSH and independent variables.RESULTS: In this study population, 8.2% had an ACSH. African-Americans were more likely to have an ACSH [AOR=1.55, 95% CI 1.16, 2.07] than Caucasians. Adults with schizophrenia were more likely to have an ACSH, compared to those without schizophrenia [AOR=1.54, 95% CI 1.16, 2.04]. Residents in counties with a higher number of community mental health centers [AOR=0.88, 95% CI 0.80, 0.97] and rural health centers [AOR=0.98, 95% CI 0.95, 0.99] were less likely to have an ASCH.CONCLUSIONS: Programs and interventions designed to reduce the risk of ACSH may be needed to target specific population subgroups and improve healthcare infrastructure.
KW - Ambulatory care sensitive hospitalization
KW - County-level factors
KW - Medicaid
KW - Quality of care
UR - http://www.scopus.com/inward/record.url?scp=85020321449&partnerID=8YFLogxK
U2 - 10.1080/21548331.2016.1144446
DO - 10.1080/21548331.2016.1144446
M3 - Article
C2 - 26788839
AN - SCOPUS:85020321449
SN - 2154-8331
VL - 44
SP - 48
EP - 59
JO - Hospital practice (1995)
JF - Hospital practice (1995)
IS - 1
ER -