Preventable Hospitalizations in Primary Care Shortage Areas: An Analysis of Vulnerable Medicare Beneficiaries

Abstract

Medicare beneficiaries in fair or poor health are more likely to experience a potentially preventable hospitalization if they live in a county designated as a primary care shortage area. Provision of Medicare coverage alone may not be enough to prevent poor ambulatory health care outcomes such as preventable hospitalizations. Improving health care outcomes for vulnerable elderly patients may require structural changes to the primary care ambulatory delivery system in the United States, especially in designated shortage areas.

Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study

“…[38][39][40][41][42][43][44][45] Primary care access and ED utilization patterns have been examined in multiple studies looking at risk for admission, with varying results. 4,6,12,13,[46][47][48] In our study, self-reported ambulatory care did not differ between the patients with strongly acuity-driven and moderately/weakly acuity-driven admissions. However, a physician's perception that patients lacked access to primary or specialty care played a role in the decisions to admit the lower acuity patients.…”

“…[4][5][6][7][8][9][10][11][12][13] For the purpose of our study, non-medical refers to all factors, other than a patient's clinical condition, that potentially influence admission decisions. In retrospective studies, non-medical factors associated with hospital admission include both patient-level (e.g., income, 4,5 insurance status, 6,7 homelessness, 8,9 spouse's health status, 10 health literacy 11 ) and system-level features (e.g., access to care, 12,13 provider continuity 14 ). But the role that these non-medical factors play in admission decisions is not well established.…”

Trends In Avoidable Hospitalizations, 1980–1998

“…3 Also, persons living in counties designated as primary care shortage areas were found to have more avoidable hospitalizations. 4 In its 1993 report, Access to Health Care in America, the Institute of Medicine (IOM) recommended that avoidable hospitalizations be used to monitor access to health care services at the national level over time, tracking whether conditions for obtaining care were improving or getting worse, especially for vulnerable population groups. 5 However, few trend analyses have been undertaken.…”

An extension in eligibility for free primary care and avoidable hospitalisations: A natural experiment

“…Much of the earlier research uses regional level data to compare avoidable hospitalisation rates among areas with differing socio-economic profiles, insurance coverage, GP density etc. (Basu et al, 2002;Bindman et al, 1995;Epstein, 2001;Gaskin et al, 2000;Nitti et al, 2003;Page et al, 2007;Pappas et al, 1997;Parchman et al, 1999;Roos et al, 2005). A number of studies undertake international comparisons of avoidable hospitalisation rates, principally between the US (with relatively M A N U S C R I P T…”

“…However, a major failing of such regional-level analyses is the potential for ecological fallacy (Epstein, 2001;Parchman et al, 1999). Using individual-level data allows researchers to control more comprehensively for individual characteristics, as well as regional and hospital-level characteristics (Blustein et al, 1998;Culler et al, 1998;Gadomski et al, 1998;Gill et al, 1998;Parker et al, 2000;Weissman et al, 1992).…”