Preventable hospitalizations, barriers to care, and disability

Area of Science:

• Health Services Research
• Public Health
• Gerontology

Background:

• Ambulatory-care sensitive (ACS) hospitalizations are potentially preventable and may signal issues with healthcare access and quality.
• The Agency for Healthcare Research and Quality (AHRQ) uses Prevention Quality Indicators (PQIs) to identify these hospitalizations.

Purpose of the Study:

• To investigate the association between healthcare barriers and ACS hospitalizations and their costs among elderly Medicare beneficiaries.
• To determine if these associations differ based on beneficiaries' disability status.

Main Methods:

• Utilized a cohort from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims.
• Analyzed the impact of various healthcare barriers (e.g., financial difficulties, care coordination, access to care) on ACS hospitalization costs.
• Stratified analyses by disability status (none, mild, moderate, severe, complete).

Main Results:

• ACS hospitalizations incurred significant excess costs, with costs rising substantially with increasing disability severity.
• Financial difficulties, low satisfaction with care coordination, and poor access to care were associated with higher ACS hospitalization costs.
• These patterns were observed in both disabled and non-disabled beneficiaries, but were more pronounced in those without functional limitations.

Conclusions:

• Healthcare barriers, including financial constraints and suboptimal care coordination, contribute significantly to preventable hospitalizations and associated costs in Medicare beneficiaries.
• Targeted interventions to improve care coordination and alleviate financial barriers are essential for reducing excess ACS hospitalizations.
• Policy efforts should focus on these areas to support the growing elderly Medicare population.