Factors that Influence
Hospitalization for Chronic
Medical Conditions
SUMMARY AND POINTS OF DISCUSSION
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1
Panel Summary

Multivariate modeling of the trend in ACSC
hospitalizations from 1993 to 2000 using
Medicare claims data showed that changes
in sociodemographic characteristics and
health status among elderly Medicare FFS
beneficiaries explained a substantial
proportion of the observed positive trend in
hospitalization rates for CHF, COPD, and
PVD
2
Panel Summary

Use of the emergency room
 strongly associated with hospitalization
for COPD and modest association for
CHF


Evidence of substitution for PVD
Rural areas that lost population
 Experienced declines in hospitalization
rates for COPD and CHF
3
Panel Summary

After controlling for changes in
demographics, health status, and migration
patterns, unexplained geographic variation
in ACSC hospitalization rates remained


Most notable for COPD and CHF in
eastern half of United States
This suggests factors not included in the
trend analysis play an important role in
hospitalization rate increases over time.
4
Panel Summary

Cross-sectional multivariate analysis using
the MCBS of likelihood of hospitalization in
2000 for an ACSC allowed for examination
of factors not in claims data

A previous hospitalization was found to be
the strongest predictor of a subsequent
hospitalization for the same chronic
condition

Having a usual source of care or
supplemental insurance did not appreciably
reduce likelihood of admission
5
Panel Summary

In our third multivariate analysis, we used
regional-level data aggregated to the level
of HRRs to examine rates of change in
acute care treatment for three chronic
conditions between two time periods

Allowed us to examine residual geographic
variation observed in the trend analysis
6
Panel Summary

Incorporated market-level information
 population characteristics
 hospital and post-acute care
availability and usage
 physician and nurse supply factors
 supplemental insurance take-up
 general and M+C managed care
penetration.
7
Panel Summary

Beneficiary characteristics aggregated to
the level of HRRs strongly influenced
rates of acute care treatment for COPD,
CHF and PVD

Poverty appeared to have the strongest
relationship with rate of hospitalization
and its influence increased over time
 Significant regional concentration
throughout the Appalachian Mountain
Region and Gulf of Mexico
8
Panel Summary

Positive association between rate of
hospitalization for COPD and proportion
of population that said they had not
visited a physician due to cost in the
latter part of the 1990s

Supply factors related to SNF and
rehabilitation care were associated with
COPD and CHF hospitalization rates
 SNF +
 Rehab –

High rates of home health visits positively
associated with PVD admission rates
9
Panel Summary



A descriptive analysis examined whether
the incidence of an ACSC hospitalization
was associated with self-reports of poor
access to care or dissatisfaction with
health care services among Medicare
FFS beneficiaries
No relationship between satisfaction with
care or customer service
Beneficiaries that had an ACSC
hospitalization were modestly more likely
to report problems getting needed
medical care
10
Policy Implications

Variation in the direction and strength of
relationship between explanatory factors
and hospitalization for the selected
chronic conditions suggest that
interventions employed to reduce
hospitalization for ACSCs may have to
be tailored to specific conditions to be
effective
11
Policy Implications

Rates of ACSC hospitalization are
strongly influenced by health status
within the Medicare FFS population
 Targeting hospitalized beneficiaries
for disease management may be a
reasonable strategy to reduce future
admissions
 Decrease overall level of morbidity
and presence of co-morbidities
12
Policy Implications

A more aggressive approach to clinically
managing beneficiaries with the studied
chronic conditions may not be sufficient
 Poverty
 Living in rural areas
 Dual enrollment in Medicare/Medicaid
13
Policy Implications

Observed regional clustering of COPD
and CHF rates suggests interventions
might be geographically targeted rather
than national in scope
14
Policy Implications

Lastly, use of ACSC hospitalizations as a
quality measure may require further
evaluation prior to widespread use
 Stark difference in trend in
hospitalization rate for COPD and
asthma
–
–
–
–
Clinically difficult to distinguish
Coding may be fungible
Were there changes in treatment?
Were there changes in payment?
 Creating
indices may mask quality
problems or quality improvement
15