Literature Tables for Utilization and ACSC Indicators

Sheryl M Davies; Jeffrey Geppert; Mark McClellan; Kathryn M McDonald; Patrick S Romano; Kaveh G Shojania

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Davies SM, Geppert J, McClellan M, et al. Refinement of the HCUP Quality Indicators. Rockville (MD): Agency for Healthcare Research and Quality (US); 2001 May. (Technical Reviews, No. 4.)

APPENDIX 8Literature Tables for Utilization and ACSC Indicators

This appendix summarizes the literature reviews for area utilization and ACSC indicators in table format.

Table 1A. Studies of appropriateness of specific procedures. This table summarizes the studies used to identify area utilization indicators.

Tables 2A-6A. These tables summarize studies of ACSC indicators. Table 2A identifies the studies and designs. Table 3A lists the ACS conditions examined in each study. Tables 4A-6A list pediatric avoidable hospitalizations, infant discretionary hospitalizations, and late hospitalization indicators examined by each study.

Table 3A focuses on conditions for which the risk of hospitalization can be reduced, either through better outpatient management of chronic diseases (e.g., asthma, CHF, diabetes) or through more timely diagnosis and effective treatment of acute conditions (e.g., pneumonia, UTI, cellulitis). This is the best validated of the 4 constructs, and is the basis for all of our selected indicators.

Table 4A includes "conditions for which evidence exists that specific ambulatory care modalities reduce hospitalization rates." This category differs from #1 in that it is more sharply focused on defects in ambulatory care, such as a lack of prior outpatient visits or antibiotic prescriptions. There is some overlap between this list and #1 (e.g., asthma, gastroenteritis, DKA, severe ENT infections, PID), although the definitions often differ slightly. Some of these indicators cannot be implemented without linked outpatient claims.

Table 5A focuses on conditions "for which the decision to admit involves a substantial amount of physician judgment...have a wide range in severity and are often managed at home." This concept seems somewhat less relevant to discussions about quality of care.

Table 6A focuses on conditions "whose advanced stages are presumed to have a greater likelihood of reflecting untimely hospital admissions" (because earlier admission would have prevented progression to the advanced stage). This concept relates to the timeliness of hospitalization and the appropriateness of inpatient care, more than to the timeliness and effectiveness of outpatient care.

Table 1A. Studies of appropriateness of specific procedures

Procedure	% inappropriate	% uncertain	Source of population	# of patients evaluated
Carotid Endarterectomy¹	18% (51/281) overall; neurosurgery 14% vs. non-neurosurgery 21%; varied from 0% to 33% among surgeons (P = 0.07)	49% (138/281) overall, decreased to 45% after adjusting for benefit of CEA for severe symptomatic disease found in NASCET; 40% neurosurgery vs. 55% non-neurosurgery; varied from 33% to 67% across surgeons (P=.26)	All in Edmonton, Alberta, Canada	291 cases of CEA performed on 265 patients between April 1994 and Sept 1995, from nine surgeons at four teaching hospitals (2 were tertiary-care centers); excluded patients without angiograms (10)
Carotid Endartectomy²⁴ *follow up to above study	4% (8/184)	47% (84/184)	All in Edmonton, Alberta, Canada	184 patients with CEA between 9/1/96 and 8/31/97 were evaluated after results of previous study, CEA guidelines and notification of possible surveillance were distributed to all surgeons performing CEA in Edmonton
Carotid Endarterectomy²	Definition A (low risk of stroke/death):~55% Definition B: ~5% Definition C:~5%	Definition A (low risk of stroke/death): ~12% Definition B: ~37% Definition C:~14%	Twelve academic medical centers	1160 randomly selected patients with CEA from 1988-1990 (with the exception of one hospital which included 1987 data), miscoded charts were excluded
Carotid Endarterectomy³	32% overall; varied from 29% to 40% among sites	32% overall; varied from 29% to 34% among sites	5 sites of varying utilization for the 3 procedures selected from Medicare claims submitted by physicians in Arkansas, Colorado, Iowa, Mass., Montana, Penn., S. Carolina, and N. Calif.	Random sample of Medicare beneficiaries for each procedure (claims submitted in 1981) at each site (high, average, and low use geographic areas)
Carotid Endarterectomy⁴	Varied by county from 0% - 67%	No discussion of equivocal indication	23 adjacent rural and urban, large and small, counties in one large, populous state	Sampled procedures by Medicare billing codes performed on 600 CEA patients in 1981, aged 65 years and older
Carotid Endarterectomy²²	3.9% characterized as inappropriate; study considered CEA inappropriate if the case was "uncertain" or "proven inappropriate".		1993 Medicare admissions in Georgia w/procedure code for CEA	1945 CEAs performed on Medicare recipients in GA in 1993
Cataract Surgery⁵	2% (15/723) overall; varied from 0% to 6% by institution	8% (359/723) overall; varied from 0% to 15% by institution	Ten Academic Medical Centers	1139 randomly selected until approx. 130 patients at each facility w/cataract surgery in 1990 were obtained; patients receiving other ocular surgery performed at the same time as cataract surgery or with specific ICD-9 CM or CPT-4 were excluded
Cholecystectomy⁶	12% overall; varied from 6%-14% (p=.002) among hospitals	17% overall; varied from 9%-24% (p=.002) among hospitals	Four Israeli hospitals belonging to the General Sick Fund (provides prepaid healthcare to 76% of Israeli population)	816 patients identified as having undergone cholecystectomy in 1986; 702 records were located and evaluated; complete clinical info was obtained on 657 patients
Colonoscopy⁷	27.8% (110/553) by ASGE criteria; 31.5% (170/553) by US 94 criteria; 25.6% (138/553) by Swiss 94 criteria	No rating for ASGE; 10.9% (59/553) by US 94 criteria; 11.6% (63/553) by Swiss 94 criteria	Two university-based multi-specialty outpatient clinics in Lausanne and Basel, Switzerland	553 consecutive patients referred by the outpatient clinics for colonoscopy, aged >15 from January 1995 to September 1995 (Lausanne) and January 1995 to July 1995 (Basel)
Coronary Angiography²⁶	7% (1/14) of blacks; 10% (4/41) whites who underwent angiography	50% (7/14) of blacks; 46.3% (19/41) whites who underwent angiography	Department of Veterans Affairs	200 (100 white and 100 black) VA inpatients discharged between 1/193 and 12/1/93 with primary dx of cardiovascular disease or chest pain
Coronary Angiography⁸	6% overall; no difference across subgroups	16% overall; no difference across subgroups	Harvard Community Health Plan (HCHP), Brookline Mass; mixed model HMO	292 HCHP enrollees with coronary angiography in 1992; stratified into four subgroups
Coronary Angiography⁹	21% overall	30% overall	Trent region; coronary angiography is done in 3 referral centers and CABG in 2 centers.	random sample of 320 patients with coronary angiography between 2/1/87 and 5/30/88. Exclusions: incomplete records, congenital heart disease, transplant, primary valve disease.
Coronary Angiography³	17% overall; varied from 15%-18% among sites	9% overall; varied from 4%-10% among sites	5 sites of varying utilization for the 3 procedures selected from Medicare claims submitted by physicians in Arkansas, Colorado, Iowa, Mass., Montana, Penn., S. Carolina, and N. Calif.	Random sample of Medicare beneficiaries for each procedure (claims submitted in 1981) at each site (high, average, and low use geographic areas)
Coronary Angiography⁴	Varied by county from 8%-75%	no discussion of equivocal indication	23 adjacent rural and urban, large and small, counties in one large, populous state	Sampled procedures by Medicare billing codes performed on 600 CA patients in 1981, aged 65 years and older
Coronary Angiography¹⁰	Canadian Criteria Canadian sample: 9.0% (95% CI, 6.6%-11.4%) New York sample: 10.2% (95% CI, 8.5%-11.8%) US Criteria Canadian sample: 5.1% (95% CI, 3.2%-6.9%) New York sample: 4.2% (95% CI, 3.4%-6.9%)	Canadian Criteria Canadian sample: 33.2% (95% CI, 29.2%-37.2%) New York sample: 39.1 (95% CI, 35.1%-43.1%) US Criteria Canadian sample: 18.2% (95% CI, 14.9%-21.5%) New York sample: 20.1% (95% CI, 18.4%-21.8%)	All hospitals performing CA and CABG in Ontario and British Columbia; 15 randomly selected hospitals that provide CA in New York State; 15 randomly selected hospitals that provide CABG in New York State	553 randomly selected patients in Canada, 1333 randomly selected patients in New York. New York patients had procedures performed in 1990; Canadian patients had procedures performed between 4/89 and 3/90. Cases performed primarily for valve surgery were excluded
Coronary Angiography¹¹	4% overall; varied from 0% - 9% among hospitals (NS)	20% overall; varied from 13%-31% among hospitals (NS)	15 randomly selected, non federal hospitals in New York State providing coronary angiography	Random sample of 1335 patients undergoing angiography in New York State in 1990, distributed across the 15 hospitals
CABG¹²	6% (5/85), compared to 1/85 identified by the original panel of NY cardiologists	12% (10/85), compared to 1/85 identified by the original panel of NY cardiologists	A follow-up to the above study was done using a sub-sample of the patients. A panel of Duke University cardiologists reviewed 308 records for appropriateness
CABG¹³	1.6% (95% CI, 0.6% - 2.5%) overall; increased to 1.9% when revised by Consortium surgeons. Varied from 0% to 5% across hospitals (P=0.02) (NS)	7% (95% CI, 5%-8%) overall; did not vary significantly across hospitals	All 12 Academic Medical Center Consortium hospitals	1156 patients w/CABG surgery in 1990 w/o previous CABG or concurrent valve replacement surgery, randomly selected consecutively until 100 records were obtained from each facility
CABG¹⁴	2.4% (95% CI, 2% - 3%) overall; varied from 0% to 5% among hospitals (NS)	7% (95% CI, 5%-9%) overall; varied from 3% to 15% among hospitals (NS)	15 randomly selected, non federal hospitals in New York State providing CABG surgery	Random sample of 1338 patients undergoing isolated CABG in NY in 1990; those undergoing another major procedure in conjunction with CABG (55) were excluded; records missing critical data (13) were also excluded
CABG⁹	16% overall	26% overall	Trent region; coronary angiography is done in 3 referral centers and CABG in 2 centers.	319 randomly selected patients with CABG between 7/1/87 and 6/31/88. Exclusions: incomplete records, congenital heart disease, transplant, primary valve disease
CABG¹⁰	Canadian Criteria Canadian sample: 3.6% (95% CI, 2.0%-5.1%) New York sample: 5.5% (95% CI, 4.0%-7.1%) US Criteria Canadian sample: 2.5% (95% CI, 1.2%-3.8%) New York sample: 2.4% (95% CI, 1.6%-3.1%)	Canadian Criteria Canadian sample: 11.3% (95% CI, 8.7%-14.0%) New York sample: 9.9% (95% CI, 8.4%-11.4%) US Criteria Canadian sample: 9.0% (95% CI, 6.6%-11.4%) New York sample: 7.0% (95% CI, 5.1%-9.0%)	All hospitals performing CA and CABG in Ontario and British Columbia; 15 randomly selected hospitals that provide CA in New York; 15 randomly selected hospitals that provide CABG in New York	556 randomly selected CABG patients in Canada, 1336 randomly selected CABG patients in New York. New York patients had procedures performed in 1990; Canadian patients had procedures performed between 4/89 and 3/90. Cases performed primarily for valve surgery were excluded
CABG (referral after Coronary Angiography)¹⁶	9.7% overall	12.3% overall	Seven of eight public Swedish heart centers. (perform 92% of all bypass surgeries in Sweden)	Consecutive series of 2767 patients with coronary angiography between 5/94 and 1/95 who were considered for coronary revascularization
CABG¹⁵	RAND criteria: 42% ACC/AHA criteria:17% RAS criteria: 46%	RAND criteria: 17% ACC/AHA criteria:no rating RAS criteria: no rating	An academic medical center cardiac catheterization laboratory and a VA cardiac catheterization lab in Maryland	153 catheterization patients referred to a either Univ. of Maryland Cardiac Catheterization Lab and/or Baltimore VA Medical Center Cardiac Catheterization Lab with a variety of cardiac diagnoses and treatments between 3/93 and 10/94
PTCA¹⁵	RAND criteria: 22% ACC/AHA criteria: 49% RAS criteria: 35%	RAND criteria: 29% ACC/AHA criteria: no rating RAS criteria: no rating	An academic medical center cardiac catheterization laboratory and a VA cardiac catheterization lab in Maryland	153 catheterization patients referred to a either Univ. of Maryland Cardiac Catheterization Lab and/or Baltimore VA Medical Center Cardiac Catheterization Lab with a variety of cardiac diagnoses and treatments between 3/93 and 10/94
PTCA (referral after Coronary Angiography)¹⁶	38.3% overall	30.0% overall	Seven of eight public Swedish heart centers. (perform 92% of all bypass surgeries in Sweden)	Consecutive series of 2767 patients with coronary angiography between 5/94 and 1/95 who were considered for coronary revascularization
PTCA¹²	12% (11/95), compared to 9/95 identified by the original panel of NY cardiologists	27% (26/95), compared to 23/95 identified by the original panel of NY cardiologists	A follow-up to reference 11 was done using a sub-sample of the patients. A panel of Duke University cardiologists reviewed 308 records for appropriateness
Diagnostic testing for Coronary Artery Disease¹⁷	3% (7/215) overall	39% (42/109) overall	Five urban Los Angeles area hospital emergency departments, 2 public, 1 private NFP, 1 university med. ctr., 1 NFP HMO	356 patients with chest pain not due to myocardial infarction or history of cardiac disease between Oct 94 and Apr 96. Those not receiving ECG during initial eval were excluded
Hip Joint Replacement²⁵	8.3% (86/997) overall; 6.7% - 16.3%. for osteoarthritis, 0% - 25.0% for avascular necrosis, 0% for fracture and revision	32.4% (334/997) overall; 42.3%-50.0% for osteoarthritis, 0%- 50.0% for avascular necrosis, 9.6%-40.0% for fracture, 3.4%-18.9% for revision	5 large public hospitals (4 university affiliated, 1 community-based)	997 patients with osteoarthritis, avascular necrosis, hip fracture, or revision who were undergoing HJR between 12/96 and 12/97
Hip and Knee Joint Replacement²¹	High-rate region: 6.1% Low-rate region: 6.4% Rated by subspecialists High-rate region: 11.4% Low-rate region: 11.0%	Not evaluated	7 high-rate region hospitals: 3 university affiliated, 4 community 8 low-rate region hospitals: 5 university affiliated, 3 community	371 patients in the high rate region and 565 in the low rate region with surgery performed between 4/1/92 and 3/31/93 without fracture or other indication, and < 60 years old
Hysterectomy¹⁸	16% overall; varied across plans from 10% to 27%	25% overall	Seven managed care organizations	Random sample of 642 hysterectomies (non-emergency and non-oncological) between 8/1/89 and 7/31/90, among women enrolled in a health plan 2 years prior to surgery
Hysterectomy²³	70% (367/497); varied from 45% to 100% across diagnoses indicative of hysterectomy	Not evaluated	Nine capitated medical groups in Southern California	497 women receiving hysterectomy between 8/93 and 7/95 in one of nine capitated medical groups in S. California
Laminectomy¹⁹	23%	29%	One Swiss University hospital	196 patients with surgical treatment for herniated discs
Lumbar Discectomy and Spinal Stenosis surgery²⁰	38% (126/328)	Combined with "appropriate" category	Two university neurosurgery departments	328 consecutive patients undergoing surgery for Lumbar Disc Hernia of Spinal Stenosis at hosp A from 4/92-10/92 and at hosp B from 5/93-9/93. Patients with neoplasms were excluded
Upper GI Tract endoscopy³	17% overall; varied from 15% to 19% among sites	11% overall; varied from 8% to 14% among sites	5 sites of varying utilization for the 3 procedures selected from Medicare claims submitted by physicians in Arkansas, Colorado, Iowa, Mass., Montana, Penn., S. Carolina, and N. Calif.	Random sample of Medicare beneficiaries for each procedure (claims submitted in 1981) at each site (high, average, and low use geographic areas)
Upper GI Tract endoscopy⁴	Varied by county from 0%-25%	Not evaluated	23 adjacent rural and urban, large and small, counties in one large, populous state	Sampled procedures by Medicare billing codes performed on 614 UGI patients in 1981, aged 65 years and older

Table 2A. Studies of ACSC indicators

Study	Payer	Level	Validating variables
Begley, 1994	all	area (city/state)	none
Bierman, 2000	all	person	income (area, all), Medicaid (asthma, diabetes), race (asthma, diabetes), race (asthma, diabetes)
Billings, 1993	all	area (zip code)	income, race (diagnosis-specific findings in Billings, 1992)
Billings, 1996	all and Canadian health system	area (zip code)	Income, national health insurance
Bindman, 1995	all	area (zip code cluster/MSSA)	self-rated access (all, but strongest for asthma, CHF, DM), income, education, uninsured, Medicaid
Blustein, 1998	Medicare	person	education, income, usual source of care, race, supplemental Medicaid or other insurance, prior physician visits
Casanova, 1995	Spanish national health system	person	illiteracy (area), unemployment (area), income (area), school enrollment (area), availability of health center, availability of pediatrician
Casanova, 1996	Spanish national health system	person	family income, paternal/maternal employment, social class, paternal/maternal education, prior physician visit, pediatrician
Claudio, 1999	all	area	income, % minority, % children under 18, lack of access to preventative health care, poor housing conditions, environmental exposures, genetic suseptibility
Connell, 1984	Medicare and Medicaid	hospitalization	reside in nursing home, payment source, quality of care (appropriate diagnostic tests, use of IV insulin)_
Culler, 1998	Medicare	person	race, education, living alone/with spouse, income, supplemental Medicaid or other insurance, problems obtaining care, health professional shortage area, core SMSA or rural county
Djojonegoro 2000	all	area (zip code)	income, race (person)
Gadomski, 1998	Medicaid	person/quarter	enrollment in Maryland Access to Care (Medicaid managed care with gatekeeper), SSI or AFDC recipients, urban residence, race
Gill, 1997	Medicaid	person	regular source of care, regular care from primary care physician
Gill, 1998	Medicaid	person	continuity index (function of number of ambulatory visits and unique providers)
Giuffrida, 1999	English Health Services Area	area	supply of secondary care (physicians, hosp beds), morbidity measures (limiting l.t. illness, permanently sick), socioeconomic characteristics (pop density, unemploy, no central heating, crowded accomodations, no car, new commonwealth, retired living alone, students, social class 1 & 2, pop mobility), year
Kaestner, 2000	all	hospital-income category -year	income
Krakauer, 1996	Medicare	area (HCSA)	race/ethnicity, supplemental Medicaid or HMO coverage, urban residence, income, unemployment, active, generalist, med spec, & surg spec MD/pop ratio, generalists/MD, med spec/MD, surg spec/MD
Laditka, 1999 (JWA)	Medicare	area (hospital market area)	income
Laditka, 1999 (JHSP)	Medicaid	area (hospital market area)	Medicaid proportion
McConnochie1997	all	area (zip code)	inner city or "other urban" residence (person), late prenatal care, maternal education, uninsured, Medicaid, race, unemployment, lack of telephone/automobile, childhood poverty
Millman, 1993	all	area	income (all except congenital syphilis, immunization/preventable, dental; gastroenteritis O:E<2)
O' Sullivan 1996	all	area	geographic region, insurance status
Pappas, 1997	all	person	race, income (area), uninsured, Medicaid)
Parchman, 1994	all	area, (HSA)	FP-GP/pop ratio, gen IM/pop ratio, gen ped/pop ratio, income
Parchman, 1999	Medicare	person	primary care shortage area, supplemental Medicaid, income, race, education, marital status
Rohrer, 1997	all	area	geographic region
Schreiber, 1997	all	area (zip code)	poverty, race, pop density, primary care MD/pop ratio, health professional shortage area, proximity to hospital
Shi, 1999	all	person	race, income (area), non-MSA, primary care MD, uninsured, Medicare/Medicaid
Shukla, 1997	all	person	race (all conditions), insurance type (diabetes, hypertension, asthma), localities
Silver, 1997	Medicare	area (county)	rural regions of Utah (0/4 anemia, 2/4 asthma, 4/4 cellulitis, 2/4 CHF, ¼ DM, ¾ gastric, 2/4 hypertension, 4/4 pneumonia
Solet, 2000	all	area	income/ poverty status
Taroni, 1997	Italian health system	area (local health unit)	low overall hospital use
Weissman, 1992	all	person	uninsured (0/2 rupt appendix, ½ asthma, 2/2 cellulitis, ½ CHF, 2/2 DM, 2/2 gangrene,½ hypokalemia, ½ immunizable, 2/2 malig. htn. 2/2 pneumonia, ½ pyelo, 2/2 ulcer), Medicaid, race

Table 3A. Studies of ACSC indicators

Study

Acute Myocardial Infarction

Acute Poliomyelitis

Anemia, Iron deficiency

Anemia, any

Angina

Asthma

Asthma & bronchitis

Cellulitis or abscess

Cellulitis, or other soft tissue infection

Cellulitis, abscess, lymphadenitis

Cellulitis with skin graft

Chest pain

Congestive heart failure

CHF (plus pulmonary edema)

CHF and shock

Congenital syphilis

Convulsions 'A' & 'B'

COPD

Dehydration/volume depletion

Dental conditions

Diabetes A

Diabetes B

Diabetes C

Diabetes w/ketoacidosis or coma

Diabetes, Uncontrolled

Diabetes with complications

Diabetes, all

Epilepsy or grand mal status

Failure to thrive

Gangrene

Gastroenteritis

Gastrointestinal hemorrhage, upper

High risk/complicated delivery

Hypertension

Hypertension, malignant

Hypoglycemia

Hypokalemia

Immunizable conditions

Immunization- related or preventable

Immunization- preventable pneumonia

Invasive cervical cancer

Kidney/UTI

Low infant birth weight

Malignant neoplasm of female breast

Measlres

Mumps

Nutritional Deficiency

Otitis Media

Pelvic Inflammatory Disease

Perforated or Bleeding Ulcer

Pneumonia, bacterial (outpatient treatable)

Pneumonia, bacterial (any)

Pneumonia or pleurisy

Pneumonia, Bronchitis, Bronchiolotis, Pharyngitis

Pneumonia, sinsusitis

Pyelonephritis

Respiriatory infections (including pulmonary TB)

Rheumatic fever

Ruptured appendix

Severe ENT infection

Stroke with hypertension

TB, other

TB, pulmonary

Begley, 1994

Adult Peds Adult & Peds

X**

Bierman, 2000

Adult Peds Adult & Peds

Billings, 1993

Adult Peds Adult & Peds

X
X

Billings, 1996

Adult Peds Adult & Peds

Bindman, 1995

Adult Peds Adult & Peds

Blustein, 1998

Adult Peds Adult & Peds

Casanova, 1995

Adult Peds Adult & Peds

Casanova, 1996

Adult Peds Adult & Peds

Claudio, 1999

Adult Peds Adult & Peds

Connell, 1984

Adult Peds Adult & Peds

Culler, 1998

Adult Peds Adult & Peds

Djojonegoro 2000

Adult Peds Adult & Peds

Gadomski, 1998

Adult Peds Adult & Peds

Gill, 1997

Adult Peds Adult & Peds

X

X

Gill, 1998

Adult Peds Adult & Peds

Guiffrida, 1999

Adult Peds Adult & Peds

Kaestner, 2000

Adult Peds Adult & Peds

Krakauer, 1996

Adult Peds Adult & Peds

Laditka, 1999 (JWA)

Adult Peds Adult & Peds

Laditka, 1999 (JHSP)

Adult Peds Adult & Peds

X
X

McConnochie1997

Adult Peds Adult & Peds

Millman, 1993

Adult Peds Adult & Peds

O'Sullivan, 1996

Adult Peds Adult & Peds

Pappas, 1997

Adult Peds Adult & Peds

Parchman, 1994

Adult Peds Adult & Peds

X
X

Parchman, 1999

Adult Peds Adult & Peds

Rohrer, 1997

Adult Peds Adult & Peds

Schreiber, 1997

Adult Peds Adult & Peds

Shi, 1999

Adult Peds Adult & Peds

X
X

Shukla, 1997

Adult Peds Adult & Peds

X

X*

Silver, 1997

Adult Peds Adult & Peds

Solet, 2000

Adult Peds Adult & Peds

Taroni, 1997

Adult Peds Adult & Peds

Weissman, 1992

Adult Peds Adult & Peds

X
X

: *Removed "diabetes mellitus without mention of complication, not stated as uncontrolled"Includes other respiratory TB (01)
: # Added benign hypertension and hypertensive renal failure
: ** Separate indicators for pregnancy (646.6+590.1) and others (590.1); removed chronic or NOS pyelonephritisIncludes other respiratory TB (012)

Table 4A. Studies of ACSC Indicators- Pediatric Avoidable Hospitalizations

Study

Acute Ottisis Media

Acute pyelonephritis

Asthma

Bronchitis

Burns

Congenital Lower Bowel Obstruction***

Diabetic ketoacidosis

Gastroenteritis

Hypernatremic***

Immunizable Diseases

Jaundice***

Mastoiditis

Nausea and Vomiting

Obstuctive Cardiac Defects***

PID

Upper Respiratory Infection

UTI

Viral Meningitis

Viral Syndrome

Volume depletion***

Gadomski, 1998

: *** Infant readmission within 2 weeks of DOB

Table 5A. Studies of ACSC Indicators-Discretionary Hospitalization of Infants

Study	Croup/Tracheitis	Failure to Thrive	Fever, acute unexplained	Gastroenteritis/ Dehydration	Gastrointestinal disorders, other	Lower Respiratory Illness	Nonspecific signs and symptoms	Seizure w/o intractactable mentioned	UTI	Viral Meningitis
Kaestner, 2000	X	X	X	X	X	X	X	X	X	X
McConnochie, 1997	X	X	X	X	X	X	X	X	X	X

Table 6A. Studies of ACSC Indicators- Late Hospitalization

Study	Appendicitis	Diverticular disease	Hernia, External	Peptic Ulcer	Pneumonia, bacterial	Uterine Fibroma
Taroni, 1997	X	X	X	X	X	X

1.: Wong JH, Findlay JM, Surez-Alamazor ME Regional performance of Carotid Endarterectomy. Stroke. . 1997;28:891–898. [PubMed: 9158621]
2.: Matchar DB, et al Influence of projected complication rates on estimated appropriate use rates for carotid endarterectomy HSR. 199732(3):325–342. [PMC free article: PMC1070194] [PubMed: 9240284]
3.: Chassin MR, et al Does inappropriate use explain geographic variations in the use of health care services: A study of three procedures. JAMA. . 1987;258:2533–2537. [PubMed: 3312655]
4.: Leape LL, et al Does inappropriate use explain small -- area variations in the use of health care services? JAMA. . 1990;236:669–672. [PubMed: 2404147]
5.: Tobacman JK, et al Assessment of appropriateness of cataract surgery at ten academic medical centers in 1990. Ophthalmology. . 1996;103:207–215. [PubMed: 8594503]
6.: Pilpel D, Fraser GM, Kosecoff J, Weitzman S, Brook RH Regional differences in appropriateness of cholecystectomy prepaid health insurance system. Public Health Rev. . 1992/93;20:61–74. [PubMed: 1305979]
7.: Froehlich F, et al Performance of panel-based criteria to evaluate the appropriateness of colonoscopy: A prospective study. Gastrointest Endosc. . 1998;48:128–36. [PubMed: 9717777]
8.: Noonan SJ, et al Relationship of anatomic disease to appropriateness ratings of coronary angiography. Arch Intern Med . 1995;155:1209–1213. [PubMed: 7763127]
9.: Gray D, Hampton JR, Bernstein SJ, Kosecoff J, Brook RH Audit of coronary angiography and bypass surgery. Lancet. . 1990;335:1317–1320. [PubMed: 1971385]
10.: McGlynn EA, et al Comparison of the appropriateness of coronary angiography and coronary artery bypass graft surgery between Canada and New York State. JAMA. . 1994;272:934–940. [PubMed: 8084060]
11.: Bernstein SJ, et al The appropriateness of use of coronary angiography in New York State. JAMA. . 1993;269:766–769. [PubMed: 8423658]
12.: Leape LL, et al Effect of variability in the interpretation of coronary angiograms on the appropriateness of use of coronary revascularization procedures. Am Heart J. . 2000;139:106–113. [PubMed: 10618570]
13.: Leape LL, et al The appropriateness of Coronary Artery Bypass Graft surgery in academic medical centers. Ann Intern Med. . 1996;125:8–18. [PubMed: 8644996]
14.: Leape LL, et al The appropriateness of use of Coronary Artery Bypass Graft surgery in New York state. JAMA. . 1993;269:753–760. [PubMed: 8423656]
15.: Ziskind AA, Lauer MA, Bishop G, Vogel A Assessing the appropriateness of coronary revascularization: The University of Maryland Revascularization Appropriateness Score (RAS) and its comparison to RAND expert panel ratings and American College of Cardiology/American Heart Association guidelines with regard to assigned appropriateness rating and ability to predict outcome. Clin Cardiol. . 1999;22:67–76. [PMC free article: PMC6655816] [PubMed: 10068842]
16.: Bernstein SJ, Brorsson B, Aberg T, Emanuelsson H, Brook RH, Werko L Appropriateness of referral of coronary angiography patients in Sweden. Heart. . 1999;81:470–477. [PMC free article: PMC1729044] [PubMed: 10212163]
17.: Carlisle DM, et al Underuse and overuse of diagnostic testing for coronary artery disease in patients presenting with new-onset chest pain. Am J Med. . 1999;106:391–398. [PubMed: 10225240]
18.: Bernstein SJ, et al The appropriateness of hysterectomy: A comparison of care in seven health plans. JAMA. . 1993;269:2398–2402. [PubMed: 8479066]
19.: Porchet F, Vader JP, Larequi-Lauber T, Costanza MC, Burnand B, Dubois RW The assessment of appropriate indications for laminectomy. J Bone Joint Surg [Br] . 1999;81-B:234–239. [PubMed: 10204927]
20.: Larequi-Lauber T, et al Appropriateness of indications for surgery of Lumbar Disc Hernia and Spinal Stenosis. Spine. . 1997;22:203–209. [PubMed: 9122803]
21.: Van Walraven C, et al Appropriateness of primary total hip and knee replacements in regions of Ontario with high and low utilization rates. [PMC free article: PMC1335222] [PubMed: 8823215]
22.: Karp HR, Flanders WD, Shipp CC, Taylor B, Martin D Carotid Endarterectomy among Medicare beneficiaries: A statewide evaluation of appropriateness and outcome. Stroke. . 1998;29:46–52. [PubMed: 9445327]
23.: Broder MS, Kanouse DE, Mittman BS, Bernstein SJ The appropriateness of recommendations for hysterectomy. Obstet Gynecol. . 2000;95:199–205. [PubMed: 10674580]
24.: Wong JH, Lubkey TB, Auarez-Almazor ME, Findlay JM Improving the appropriateness of Carotid Endarterectomy: Results of a prospective city-wide study. Stoke. . 199;30:12–15. [PubMed: 9880381]
25.: Quintana JM, Azkarate J, Goenaga JI, Ar?stegui I, Beldarrain I, Villar JM Evaluation of the appropriateness of hip joint replacement techniques. Intl J Tech Assessment in Health Care. . 2000;16:165–177. [PubMed: 10815362]
26.: Ferguson JA, Adams TA, Weinberger M Racial differences in cardiac catheterization use and appropriateness. Am J Med Sci. . 1998;315:302–306. [PubMed: 9587086]

References

1.: Begley, C, Slater CH, Engel MJ, Reynolds TF Avoidable hospitalization and socio-economic status in Galveston County, Texas. J Comm Health. . 1994;19:377–387. [PubMed: 7836558]
2.: Bierman AS, Steiner C, Friedman B, Fillmore CM, Clancy CM Ambulatory Care Sensitive Conditions: A viable indicator of access to quality primary care. Available at http://www.ahsr.org/1999/abstracts/bierman.htm. Accessed: 5/18/00. Abstract.
3.: Billings J, Anderson GM, Newman LS Recent findings on preventable hospitalizations. Health Affairs. . 1996;15:239–249. [PubMed: 8854530]
4.: Billings J, Zeitel L, Lukomnik J, Carey TS, Blank AE, Newman L Impact of socioeconomic status on hospital use in New York City. Health Affairs. . 1993;Spring:162–173. [PubMed: 8509018]
5.: Bindman AB, Grumbach K, Osmond D, et al Preventable hospitalizations and access to health care. JAMA. . 1995;274:305–311. [PubMed: 7609259]
6.: Blustein J, Hanson K, Shea S Preventable hospitalizations and socioeconomic status. Health Affairs. . 1998;17:177–189. [PubMed: 9558796]
7.: Cassanova C, Colomer C, Starfield B Pediatric hospitalization due to ambulatory care-sensitive conditions in Valencia (Spain). Intl J Quality in Health Care. . 1996;8:51–59. [PubMed: 8680817]
8.: Cassanova C, Starfield B Hospitalizations of children and access to primary care: A cross-national comparison. Intl J of Health Services. . 1995;25:283–294. [PubMed: 7622319]
9.: Claudio L, Tulton L, Doucette J, Landrigan PJ Socioeconomic factors and asthma hospitalization rates in New York City. J Asthma. . 1999;36:343–350. [PubMed: 10386498]
10.: Connell FA, Blide LA, Hanken MA Clinical correlates of small area variations in population-based admission rates for diabetes. Med Care. . 1984;22:939–949. [PubMed: 6436591]
11.: Culler SD, Parchman ML, Przybylski M Factors related to potentially preventable hospitalizations among the elderly. Med Care. . 1998;36:804–817. [PubMed: 9630122]
12.: Djojonegoro BM, Williams AF Area Income as a predictor of preventable hospitalizations in the Harris County Hospital District, Houston. Tex Med. . 2000;96:58–62. [PubMed: 10682419]
13.: Epstein AJ The role of the medical market in preventable hospitalizations [abstract] Abstract Book/Association for Health Services Research . 1998;15:316–7.
14.: Gadomski A, Jenkins P, Nichols M Impact of a Medicaid provider and preventive care on pediatric hospitalization Peds 1998101(3):E–1. [PubMed: 9481020]
15.: Gill JM, Mainous AG The role of provider continuity in preventing hospitalizations. Arch Fam Med . 1998;7:352–357. [PubMed: 9682689]
16.: Gill JM Can hospitalizations be avoided by having a regular source of care? Fam Med. . 1997;29:166–71. [PubMed: 9085096]
17.: Giuffrida A, Gravelle H, Roland M Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes. BMJ. . 1999;319:94–98. [PMC free article: PMC28159] [PubMed: 10398635]
18.: Halterman, JS, Aligne A, Auinger P, McBride JT, Szilagyi PG Inadequate therapy for asthma among children in the United States. Peds. . 2000;105:272–276. [PubMed: 10617735]
19.: Kaestner R, Racine A, Joyce T Did recent expansions in Medicaid narrow socioeconomic differences in hospitalizations rates of infants. Med Care. . 2000;38:195–206. [PubMed: 10659693]
20.: Krakauer H, Jacoby I, Millman M, Lukomnik JE Physician impact on hospital admission and on mortality rates in the Medicare population. HSR. . 1996;31:191–211. [PMC free article: PMC1070113] [PubMed: 8675439]
21.: Laditka SB, Johnston JM Preventable hospitalization and avoidable maternity outcomes: Implications for access to health services for Medicaid recipients. J Heath & Social Policy. . 1999;11:41–55. [PubMed: 10620859]
22.: Laditka SB, Laditka JN Geographic variation in preventable hospitalization of Older Women and Men: Implications for access to primary health care. J Women & Aging. . 1999;11:43–56. [PubMed: 10721688]
23.: McConnochie KM, Roghmann KJ, Liptak GS Socioeconomic variation in discretionary and mandatory hospitalization of infants: An ecologic analysis. Peds. . 1997;99:774–784. [PubMed: 9164768]
24.: O'Sullivan MJ, Volicer B Preventable Hospitalizations: A tool for planning and marketing ambulatory health care services. J Ambulatory Care Manage. . 1996;19:84–95. [PubMed: 10156660]
25.: Ordoñez GA, Phelan PD, Olinsky A, Robertson CF Preventable factors in hospital admissions for asthma. Arch Dis Child. . 1998;78:143–147. [PMC free article: PMC1717453] [PubMed: 9579156]
26.: Pappas G, Hadden WC, Kozak LJ, Fisher GF Potentially avoidable hospitalizations: Inequalities in rates between US socioeconomic groups. Am J Pub Health. . 1997;87:811–816. [PMC free article: PMC1381055] [PubMed: 9184511]
27.: Parchman ML, Culler S Primary care physicians and avoidable hospitalization. J Fam Prac. . 1994;39:123–128. [PubMed: 8057062]
28.: Parchman ML, Culler SD Preventable hospitalizations in primary care shortage areas: An analysis of vulnerable Medicare Beneficiaries. Arch Fam Med. . 1999;8:487–491. [PubMed: 10575386]
29.: Rohrer JE, Vaughan M Monitoring health care system performance in Iowa. Health Srvs Manage Research. . 1997;10:107–112. [PubMed: 10173079]
30.: Schreiber S, Zielinski T The meaning of ambulatory care sensitive admissions: Urban and Rural Perspectives. J Rural Health. . 1997;13:276–284. [PubMed: 10177149]
31.: Shi L, Samuels ME, Pease M, Bailey WP, Corley EH Patient characteristics associated with hospitalizations for ambulatory care sensitive conditions in South Carolina. S Med J. . 1999;92:989–998. [PubMed: 10548172]
32.: Shukla RK, Pestian JP Small area analysis of ambulatory care sensitive conditions in Virginia [abstract] Abstract Book/Association for Health Services Research. . 1997;14:9–0.
33.: Silver MP, Babitz ME, Magill MK Ambulatory care sensitive rates in the aged Medicare population in Utah, 1990 to 1994: A rural-urban comparison. J Rural Health. . >1997;13:285–294. [PubMed: 10177150]
34.: Solet D, Krieger J, Stout J, Lui L Childhood asthma hospitalizations - King County, Washington, 1987-1998. www.cdc.gov/mmwr/preview/mmwrthml . Last accessed 10/19/00. CDC MMWR Weekly. . 2000;49:929–933.
35.: Taroni F, Repetto F, Louis DZ, Moro ML, Yuen EJ, Gonnella JS Variation in hospital use and avoidable patient morbidity. J Health Services Research and Policy. . 1997;2:217–222. [PubMed: 10182250]
36.: Weissman JS, Gatsonix C, Epstein AM Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. JAMA. . 1992;268:2388–2394. [PubMed: 1404795]

Bookshelf ID: NBK43841

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