More hospitalized than needed if treated earlier

Tennesseans were more likely than other Americans to be hospitalized for pneumonia, dehydration and 11 other complaints that are often successfully treated on an outpatient basis.
The analysis by two Memphis researchers suggests the network of public and private clinics and health providers that state residents rely on for primary care is inadequate and in urgent need of improvement.

The paper was written by Dr. Cyril Chang, a University of Memphis economics professor, and Dr. Manoj Jain, quality improvement director with QSource, a Medicare quality improvement organization. The work was published recently in Tennessee Medicine, the journal of the Tennessee Medical Association.

The researchers reported that nearly 16 percent of 2002 hospitalizations statewide involved complaints for which the risk, expense and inconvenience of in-patient care might have been avoided with appropriate care in a clinic or physician's office.

The study focused on health problems for which hospitalization is considered potentially avoidable if individuals receive effective primary care in time to prevent serious complications. "These shouldn't be confused with 'unnecessary' or 'inappropriate' hospitalizations. A potentially avoidable hospitalization can actually be quite appropriate and necessary once the patient is sick enough to be admitted," Chang said.

The findings should serve as a red flag to public health officials, health providers and health insurance companies about possible gaps in the public and private network of primary care providers, Chang said.

In 2005, the state earmarked millions of dollars to expand the hours and staff at health department clinics statewide. The additional funding came as the state cut roughly 191,000 adults from its TennCare health insurance program. The cuts came as the state struggled to control health expenditures.

Chang declined to speculate on the likely impact of those efforts on hospitalization for the ailments like diabetes included in this study.

Hospitalization rates in Tennessee outpaced the national average in 12 of the 13 diagnoses studied. Chest pain was the lone category in which state residents were more likely than the average Americans to be treated outside the hospital. But Tennessee rates of hospitalization for bacterial pneumonia and congestive heart failure were dramatically higher.

A recent study by the federal Agency for Healthcare Research and Quality estimated that in 2000 the right outpatient care would have resulted in nearly 5 million fewer hospital admissions nationwide. The likely savings would have topped $26.8 billion.

The diagnoses "are believed to be a reliable indicator of the access to and quality of the ambulatory care system that serves the general population".

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