Getting better at preventing hospital visits, but still worse than average

By Mark Guydish - [email protected]

Luzerne County has made impressive gains in avoiding potentially preventable hospitalizations — the rate dropped by 19 percent since 2008 — but admissions that likely could have been avoided still occur much more frequently here than statewide.

The Pennsylvania Health Care Cost Containment Council released a research brief Thursday morning on “potentially preventable hospitalizations,” defined “by a set of Prevention Quality Indicators developed by the Agency for Healthcare Research and Quality.”

If it sounds a little debatable, it is. The council brief puts the emphasis on “potentially preventable,” noting hospital stays that likely were readily preventable among younger patients might be “less so for older patients in a weakened state.”

Specifically, the report lists 11 conditions where hospitalization may have been avoided through “early detection, timely care and patient education”: heart failure, Chronic Obstructive Pulmonary Disease or asthma for those 40 and older, asthma for those ages 18 to 39, pneumonia, dehydration, urinary tract infection, long-term and short-term complications from diabetes, uncontrolled diabetes, hypertension, and lower extremity amputation among those with diabetes.

Statewide, the rate of potentially avoidable hospitalizations was 220.9 per 10,000 residents. In 2017, it was 158.2. That’s a 28 percent decline. In Luzerne County, the rate dropped from 234.5 per 10,000 residents to 189.8. It may be a sizable drop, but it is a much smaller change than the state saw overall.

In fact, even with the improvement, Luzerne County’s rate arguably has gotten worse when compared to the state. In 2008, the county rate was 6 percent higher than the state rate. In 2017, it was 20 percent higher.

Three neighboring counties similarly saw their rates of potentially preventable hospitalizations go down yet still remain at a higher rate than the state: Lackawanna County went from 253.3 per 10,000 residents to 192, Carbon County went for 254.8 to 163, and Schuylkill County dropped from 268.8 to 183.6.

As is often the case when the Council reviews health data at the county level, Philadelphia County had the worst rate of potentially preventable hospitalizations, with 228.8 cases per 10,000 residents last year. At that, it was still a big improvement from 2008, when the rate was 321.7.

Where do you have the best chance, statistically, to avoid a preventable admission?

You don’t have to move too far. Sullivan County had the lowest rate in the state in 2017, 35.8 per 10,000 residents, down from 191.5 in 2008. There is the usual caveat for the rural county: Small numbers mean big changes in percentages and rates. Sullivan County had only 103 potentially preventable hospitalizations in 2008 and dropped to 84 in 2017. By comparison, Luzerne County had 5,955 cases in 2008 and 4,986 in 2017.

Put another way, Luzerne County had 969 fewer potentially preventable hospitalizations from 2008 to 2017, compared to Sullivan county’s decline of 19 cases. The reason such a big numeric difference doesn’t translate into a similarly big change in the rate per 10,000 residents is simple. According to the U.S. Census, Luzerne County has a population of 318,449. Sullivan County, by comparison, has a scant 6,328 residents.

By Mark Guydish

[email protected]

Reach Mark Guydish at 570-991-6112 or on Twitter @TLMarkGuydish

Reach Mark Guydish at 570-991-6112 or on Twitter @TLMarkGuydish