Primary Care Plays Central Role in Reducing Hospitalizations, Study Says

Effective primary care and other outpatient treatments could prevent millions of unnecessary hospitalizations each year while saving billions of dollars in annual health care costs, according to a new report conducted by the Agency for Healthcare Research and Quality, or AHRQ.

The report suggests that three key factors -- improvements in ambulatory care, greater access to effective treatments and patient adoption of healthy behaviors -- could potentially prevent more than 4 million hospitalizations each year, saving billions of dollars in the process.

In 2004, hospitals spent about $29 billion on care for 12 potentially preventable conditions in adults, including congestive heart failure, $8.3 billion; asthma, $1.4 billion; urinary tract infections, $2.1 billion; and high blood pressure, $509 million, according to the report "Trends in Potentially Preventable Hospitalizations Among Adults and Children, 1997-2004" (9-page PDF; About PDFs). Total cost estimates in the study also were based on four pediatric conditions that did not have to result in hospitalizations. Those conditions were short-term diabetes complications (i.e., diabetic ketoacidosis, hyperosmolarity and coma), $61 million; asthma, $326 million; gastroenteritis, $241 million; and urinary tract infections, $109 million.

The study uses statistics from the Healthcare Cost and Utilization Project's 2004 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in community hospitals. Data are taken from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type or lack of insurance.

"We want to show the numbers because numbers always help people get a better sense of how severe the problem is, which in this case concerns both the cost and quality of health care," said Joanna Jiang, Ph.D., a senior research scientist for AHRQ and a co-author of the study, in an interview with AAFP News Now. "Hopefully, providers, policy-makers and the general public will all take action from here."

Jiang stressed the importance of primary care and preventive care and, in particular, the ability of physicians to manage patient care to keep patients out of the hospital. The report defines preventable hospitalizations as conditions that would not require hospitalization if patients received timely and effective treatment in the outpatient setting, Jiang said. In this way, primary care assumes a prominent, if not a dominant, role in managing patient care and preventing chronic conditions from deteriorating to the point that hospitalization is required, according to Jiang. Thus, it is a determining factor in improving care and reducing costs.

The report found that hospital admissions for several conditions, including those cited in the report, remained stable or declined slightly from 1997 to 2004; however, related total hospital costs increased by 31 percent when adjusted for inflation, a result of increases in the severity of illness and the complexity of care over time, Jiang said. Technological advancements also have contributed to the increase in costs, she noted. More people with heart disease, for example, have pacemakers or defibrillators, requiring hospitalization to implant the devices, which further increases the cost of care.