William & Mary

Avoiding Preventable Hospitalizations

A recent study by the Schroeder Center for Health Policy at William & Mary uses Virginia data to look at one reason why some parts of Virginia have higher rates of avoidable hospitalizations than others.

Avoidable hospitalizations, or hospitalizations for a set of conditions including hypertension, diabetes, and urinary tract infections, among others, constitute 12% of Medicare inpatient spending. They are called “avoidable” because they occur when patients have poor access to primary care or receive poor quality primary care. Limiting these hospitalizations cannot only curb Medicare spending, but it can also protect patients from unnecessary hospital stays and illnesses.

The Schroeder Center’s new study uses Virginia hospital discharge records to measure rates of avoidable hospitalizations among adults age 65 and up. The main focus of this study is whether having more primary care physicians nearby is linked to fewer avoidable hospitalizations. “What’s unique about this study is the way we measure primary care physician access,” said Michael Daly, one of the study authors. “Rather than simply counting the doctors in a county, and dividing by the population in the county, we use geospatial methods to construct a better measure … we pinpoint doctors’ locations on the map, and we construct measures of physician access that allow for the fact that patients can go to doctors near their residence – even if that doctor is outside their county boundary.” As the study authors stress, this technique has not been used before to study avoidable hospitalizations among older adults.

The study finds that areas in Virginia with more primary care physicians per capita within a 30-minute driving radius have significantly lower avoidable hospitalization rates. This finding is based on models that control for various factors, like median household income, poverty rates, the age distribution of the older adult population, and measures of health system traits, like distance to the nearest hospital, and the number of non-physician clinicians nearby.

The importance of this finding is explained by Jennifer Mellor, W&M professor and one of the study’s authors. “As part of the ACA, there has been a major effort to increase access to health insurance in this country, through subsidies, mandates, and Medicaid expansions,” Mellor said. “Our study shows that when you look at a population of older adults, who notably have near universal insurance through Medicare, there are still gaps in their access that translate to unnecessary hospital care and unwanted health complications.” This suggests that even if all persons had health insurance, states and communities need to think carefully about other dimensions of access, not only financial access, but geographic access as well.    

The study is slated for publication in an upcoming issue of Health Services Research. An “early view” release of the study is available online here.