Potentially Preventable Hospital and Emergency Department Events: Lessons from a Large Innovation Project

Area of Science:

• Health Services Research
• Patient Care Management
• Chronic Disease Management

Background:

• Reducing potentially preventable hospitalizations and Emergency Department (ED) visits is a key challenge in healthcare.
• Complex patients with multiple chronic conditions often experience high rates of these events.
• Effective strategies for prevention are limited, necessitating further investigation into contributing factors.

Purpose of the Study:

• To document potentially preventable hospitalizations and ED visits among complex patients.
• To identify factors contributing to these events within a large care-improvement initiative.
• To evaluate the association between patient characteristics, disease control, and preventable events.

Main Methods:

• An observational study involving retrospective audits and interviews with care managers.
• Data collected from 373 adult patients across 12 diverse medical groups.
• Analysis of 389 hospitalizations or ED visits over a 12-month period.

Main Results:

• 28% of all events were deemed potentially preventable (39% of ED visits, 14% of hospitalizations).
• A small proportion of patients (4.6%) accounted for a significant portion (40%) of events.
• Potentially preventable events were more frequent with limited insurance, patient resources, caretaker support, understanding of care, or clinic access.

Conclusions:

• Patient characteristics, disease control, and ambulatory care-sensitive conditions were not significantly associated with potentially preventable ED visits or hospital admissions.
• The reliance on ambulatory care-sensitive conditions as a proxy for preventable events requires further examination.
• Focusing on patient-level barriers such as socioeconomic factors and access to care may be more effective in reducing preventable events.