Ambulatory Care Sensitive Hospitalizations among Medicaid Beneficiaries with Chronic Conditions

ABSTRACT

Objectives: This study examined the relationship between ambulatory care sensitive hospitalizations (ACSH) and patient-level and county-level variables. Methods: Utilizing a retrospective cohort approach, multi-state Medicaid claims data from 2007-2008 was used to examine ACSH at baseline and follow-up periods. The study cohort consisted of adult, non-elderly Medicaid beneficiaries with chronic physical conditions, who were continuously enrolled in fee-for-service programs, not enrolled in Medicare, and did not die during the study period (N=7,021). The dependent variable, ACSH, was calculated in the follow-up year using an algorithm from the Agency for Healthcare Research and Quality algorithm. Patient-level (demographic, health status, continuity of care) and county-level (density of healthcare providers and facilities, socio-economic characteristics, local economic conditions) factors were included as independent variables. Multivariable logistic regression models were used to examine the relationship between ACSH and independent variables. Results: In this study population, 8.2% had an ACSH. African-Americans were more likely to have an ACSH [AOR=1.55, 95% CI 1.16, 2.07] than Caucasians. Adults with schizophrenia were more likely to have an ACSH, compared to those without schizophrenia [AOR=1.54, 95% CI 1.16, 2.04]. Residents in counties with a higher number of community mental health centers [AOR=0.88, 95% CI 0.80, 0.97] and rural health centers [AOR=0.98, 95% CI 0.95, 0.99] were less likely to have an ASCH. Conclusions: Programs and interventions designed to reduce the risk of ACSH may be needed to target specific population subgroups and improve healthcare infrastructure.

KEYWORDS::

• Ambulatory care sensitive hospitalization
• County-level factors
• Medicaid
• Quality of care

Acknowledgements

We would like to thank Dr. Traci LeMasters, PhD (Research Assistant Professor, Department of Pharmaceutical Systems and Policy, West Virginia University) for providing editorial assistance for our manuscript.

Financial and competing interests disclosure

Research reported in this publication was supported by the Training Program in the Behavioral and Biomedical Sciences (BBS) at West Virginia University NIGMS grant T32 GM08174 and the National Institute of General Medical Sciences of the National Institutes of Health under Award Number U54GM104942. The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institutes of Health. The funders had no role in study design, data collection and analyses, decision to publish, or preparation of the manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.