Hospitalizations that might have been avoided if patients had received timely and
effective ambulatory care increased by two thirds from 1980-98 according to results
from the Centers for Disease Control and Prevention's National Health Care Survey,
published in the March-April 2001 issue of Health Affairs.
The number of hospitalizations for avoidable conditions rose from 2.2 million in
1980 to 3.7 million in 1988–from 5.9 percent to 11.5 of all hospitalizations.
Avoidable conditions, as determined by a panel of physicians, are those for which
timely and appropriate ambulatory care should prevent the illness, control an acute
episode or manage a chronic condition so that hospitalization is generally
unnecessary. However, the study recognized that not all hospitalizations for each
condition, depending upon severity of the condition and other factors, could be
Hospitalization rates increased for pneumonia, congestive heart failure, and
cellulitis. In addition, the survey indicated that hospitalization rates were also up
for ruptured appendix and potassium deficiency. However, rates were down for asthma,
perforated or bleeding ulcer and inflammation of the kidney.
Over the past two decades, avoidable hospitalizations increased substantially for
older Americans. For those under age sixty-five avoidable hospitalizations declined
for white patients, but were up among black patients.
Regardless of source of payment–Medicaid, Medicare, private insurance or
self-pay–avoidable hospitalizations increased from 1980 to 1998. The highest level
for hospitalizations (one in five) was for those 65 and over with Medicare and
Medicaid shown as the source of payment.
"Trends in Avoidable Hospitalization, 1980-1988," is based on data from
the National Hospital Discharge Survey, one of the components of CDC's National Health
Care Survey. Other components of the health care survey obtain data from surveys of
ambulatory care provided in physicians' offices, hospital emergency and outpatient
departments; nursing homes; and hospice and home health agencies.
"Trend Data on Medical Encounters: Tracking a Moving Target" uses the
full range of health care data to examine how medical care use has changed over the
past fifteen years. Since 1985, the general trends indicate that hospital discharge
rates decreased–down about 20 percent. However, nursing home discharge rates rose
more than any other segment of medical care, reflecting the aging of the U.S.
population. Between 1992 and 1996, home health care expanded rapidly, but declined in
1998. The number of agencies providing home and hospice care services doubled between
1992 and 1998.
The analysis shows little change in the rate of visits to physicians, but there
were notable changes in the content of the visit. Patients were more likely to have
medicines prescribed, continued or provided during their visits. There were increases
in the prescribing of antidepressants and the study also showed a drop in the use of
antibiotics for children.
Nursing home residents in 1997 were more disabled and received more services than
they did in 1985. This may reflect the availability of alternative services such as
home health care which allows people to postpone or avoid a nursing home.
For more information on the National Health Care Survey, conducted by CDC's
National Center for Health Statistics and access to current and trend data, check the
CDC website at http://www.cdc.gov/nchs.