Potentially avoidable hospitalizations in Tennessee: analysis of prevalence disparities associated with gender, race, and insurance.

OBJECTIVES: We determined (1) the relative rates of potentially avoidable hospitalizations (PAHs) in Tennessee; (2) relative rates of PAHs among gender, race, and insurance subgroups; and (3) adjusted population-based relative rates of PAHs, taking into account the influences of unobservable factors such as patient preferences, physician practice patterns, and availability of hospital beds that can also affect PAHs.
METHODS: We applied the Agency for Healthcare Research and Quality's definitions of ambulatory care sensitive conditions (ACSCs) to Tennessee hospitalization records to identify PAHs. Patient discharge records for 2002 came from Tennessee's Hospital Discharge Data System. Population estimates came from the U.S. Census Current Population Survey. Hospital discharges with a complete record from all nonfederal acute-care hospitals in Tennessee were considered.
RESULTS: The relative rates of PAHs in Tennessee were higher than the U.S. rates in each of the ACSC categories. The relative rates were sensitive to adjustment for unmeasured factors such as patient preferences, physician practice patterns, and the physician supply that were reflected implicitly in the hospitalization rates of each subgroup for all discharge conditions. Within Tennessee, the type of insurance each person held was the greatest determinant of the likelihood of having a PAH, particularly for a chronic condition.
CONCLUSIONS: The results indicate poor health of the general population in Tennessee and suggest opportunities to improve the provision of primary care for specific ACSCs and population subgroups to reduce PAHs, particularly the uninsured and individuals enrolled in Tennessee's Medicaid managed care program.