Lori Suzanne
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Lori Suzanne

  • Use in public reporting by state agencies and others to investigate issues of access to care at a regional level
  • Measure risk-adjusted healthcare system performance across communities
  • Identify community need levels
  • Follow trends in the potentially preventable admissions over time
  • Measure the quality of outpatient care including access and quality of care
  • Help set the direction for more in-depth investigations into healthcare system performance
  • Help target resources
  • Track the impact of programmatic and policy interventions
  • Understand factors outside the control of the health system, like socioeconomic status, health behaviors, and environmental conditions
  • PQIs rates across communities that would exist even within optimum outpatient care conditions
  • Relationship between rural-urban location and distance to health care resources and hospital admission for ambulatory care sensitive conditions
  • Relationship between hospitalization for ACSCs and the supply of medical services and resources
  • Use of outpatient data to examine associations between processes of care and the PQIs
  • Use of emergency departments for ACSC not resulting in an admission
  1. Measure the prevalence and distribution of potentially preventable hospitalizations
  • Gounder (2016) Baseline to set goals for a new state-level policy initiative to reduce ACSC hospitalizations
  • Figueroa (2017) Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries
  • Evans (2015) Community health centers density and preventable hospitalizations among Medicaid and uninsured patients
  • Hutchison (2018) Free health clinics access and preventable hospitalizations
  • Bocour (2016) Describe neighborhood poverty and preventable hospitalizations trends over time
  • Huang (2018) Explore relationships among neighborhood poverty, spatial access to care, ACSC ED visits
  • Mukamel (2017) Little is known about the effectives of policies to reduce disparities in admissions over time
  • Dresden (2015) ACSC hospitalizations through the ED by payer before and after Medicaid expansion
  • Sharma (2017) ED and ACSC hospitalizations for the uninsured before and after Medicaid expansion
  • Burke (2015) Access to care and health outcomes among already-insured Medicaid members after Medicaid expansion
  • Yaquoob (2018) Results of clinical integration efforts at a health care system and preventable hospitalizations for diabetes
  • Edwards (2017) Examine how medical complexity modifies the relationship between enrollment in home-based primary care and ACSC hospitalizations
  • Pollack (2015) Patient sharing in primary care practice and hospitalizations
  • Pezzin (2018) Explored associations between self-reported access to care and hospitalizations by disability status because disabled population are associated with access to care challenges; explores face validity for the indicators’ measure of access to care
  • Gray (2014) Maintenance of medical board certification and healthcare outcomes
  • Landon (2014) Effects of primary care compensation strategies and quality of care
  • Landon (2014b) Primary care practice intensity and quality of care
  • Patel (2016) Compare PQIs hospitalizations with physician chart review identified as preventable hospitalizations; identify factors contributing to potentially avoidable hospitalizations and feasibility of prevention
  • Daniels (2018) Qualitative case study on physician decision-making surrounding potentially preventable admissions
  • Gao (2014) Develop a predictive model to identify high-risk patients for early intervention to reduce ACSC hospitalizations; explore the predictive power of different factors
  1. PQIs were highly concentrated within subpopulations (age, race/ethnicity, other population segmenting taxonomies), condition-specific and associated with access to care
  • Gounder (2016) Highest PQIs rates were among minority and adults aged 85 or greater and efforts to reduce admissions in these groups may yield greatest benefit
  • Figueroa (2017) High cost frail elderly persons were only 4% of the Medicare population, but accounted for 43.9% of the PQI identified total potentially preventable spending while subgroups with minor chronic conditions made up only 11% of the potentially preventable spending, despite comprising more than 55% of the population
  • Evans (2015) Health centers, measured as density, were associated with lower preventable hospitalizations
  • Hutchison (2018) At the county-level, free clinics were associated with lower ACSC hospitalizations among the uninsured
  • Bocour (2016) While preventable hospitalization rates have decreased over time, disparities still exist; the rates for very high poverty neighborhoods were two to four times higher than low poverty neighborhoods
  • Huang (2018) Neighborhood socioeconomic characteristics and spatial access to healthcare affect the rate of elderly ACSC ED visits; less access to general practices and greater access to hospitals was associated with higher ACSC ED rates at the zip code level
  • Mukamel (2017) Disparities by race persist; policies should address these racial disparities in quality of ambulatory care for African-Americans; focus on chronic PQIs
  • Burke (2015) Found no evidence of impaired primary care access and negative consequences, as measured by the PQIs, from Medicaid expansion among already-insured Medicaid beneficiaries who traditionally have had the greatest barriers to obtaining care
  • Dresden (2015) Expansion of Medicaid over the study period was not associated with an increase in ED ACSC hospitalizations for Medicaid patients; these findings may indicate that as Medicaid expansion improved access to care, ACSC hospitalizations decreased; alternatively, these results could indicate that the newly enrolled Medicaid beneficiaries were healthier
  • Sharma (2017) ED visits for the uninsured declined dramatically after ACA implementation but visits resulting in ACSC hospitalization remained stable; despite population-level payer shifts, PQI prevalence continued pre-and-post health reforms
  • Edwards (2017) Enrollment in home-based primary care was only associated with fewer ACSC hospitalizations in the most medically complex individuals; conversely, in the lowest risk patients, enrollment was associated with greater odds of ACSC hospitalization
  • Pezzin (2018) Persons reporting having foregone or delayed needed medical care because of financial difficulties, those experiencing low satisfaction with care coordination, and those reporting low satisfaction with access to care incurred significant excess ACSC hospitalization costs relative to persons reporting no such barriers; this reported barrier pattern held true for those with and without a disability, but was especially marked among persons with no disability. Care coordination and reducing financial barriers may be important to reducing excess hospitalizations
  • Gray (2014) Maintenance of certification requirement was not associated with a difference in the increase in ACSC hospitalizations but was associated with a small reduction in the growth differences of costs for a cohort of Medicare beneficiaries
  • Landon (2014) Patients treated by more costly physicians were more likely to receive recommended preventive services, but were also more likely to experience preventable admissions
  • Landon (2014b) Employed physicians paid via productivity-based reward formulae were generally associated with higher quality care; relationship with preventable admissions was variable with no consistent relationship between payment arrangements and the rate of acute or chronic PQI admissions
  • Patel (2016) A large proportion of admissions appeared preventable in chart review, but the PQI tool was unable to identify these same admissions. There was limited overlap between admissions identified as preventable on an individual basis by chart review and admissions identified as preventable on a population-level basis by the PQIs. Of the preventable admissions, physicians assigned patient factors in 44%, clinician factors in 30% and system factors in 26%. Of the preventable admissions, 52% were considered very or somewhat easy to prevent and attributed to thresholds and reasons for admission.
  • Daniels (2018) Physicians determined that 1 in 5 hospital admissions were potentially preventable; focusing on “gray zone” admissions when there was no clear decision for hospital admission may be an approach for reducing admissions by understanding patient factors, system factors, risk-benefit, outpatient access
  • Gao (2014) new predictive model demonstrated that administrative data can be effective in predicting PQI identified hospitalizations; among other factors, hospital characteristics and practice patterns may play a significant role in ACSC hospitalizations.

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Lori Suzanne Schomp

Lori Suzanne Schomp

Consultant, healthcare analytics and operations

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