Outcome Indicator: Avoidable Hospitalization for Acute Conditions

For the purposes of this indicator, hospitalizations are hospital admissions for conditions related to an acute episode of disease. Avoidable hospitalizations are those that probably would not have occurred had the patient received appropriate and timely outpatient (ambulatory) medical care.

People who are in good to excellent health—the population of interest in this objective—may seek medical attention for any number of reasons. (See the discussion for the indicator ''Routine Physician Contacts" above.) The personal health care system in some cases provides only symptomatic relief to patients for conditions that would resolve independent of any medical intervention. In other situations, however, symptoms that are not addressed in a timely fashion can evolve into acute medical problems requiring hospitalization.

For example, a child with pain and fever may be treated by a parent with an over-the-counter cold medication. If the child is from a family with no regular source of medical care and if the symptoms become severe enough, a visit to the emergency room may become necessary. An emergency room physician, unaware that there has been a history of these infections, may release the child to his or her parents. At home the child may get progressively worse and eventually develop severe otitis media requiring hospitalization.

There are many other examples of potential problems faced by people without a regular source of medical care. Someone who experiences frequent urination, a burning sensation, or intermittent pain upon urination, indicating a relatively simple-to-treat urinary tract infection, may, if untreated, be at risk for developing a severe kidney infection. A persistent cough can signal any number of conditions, including tuberculosis or pneumonia. Untreated diarrhea can evolve into severe gastroenteritis.

For the significant segment of the population with no or inadequate health insurance, or who for other reasons have no regular source of medical care, hospital emergency rooms are increasingly being used as walk-in clinics for all manner of health complaints. Although few would maintain that the hospital emergency department is an optimum site for primary care, in the absence of a well-organized system of ambulatory care for those unable to afford private medical care, it is one of the only options. Unfortunately, especially in inner-city hospitals, inpatient bed space is limited. Many emergency rooms overflow not only with patients waiting to be seen by a doctor but also with patients who are already evaluated and are waiting to be assigned a hospital bed. Some evidence suggests that a significant proportion of emergency room patients with serious medical conditions leave the hospital without ever being seen. One of two recent studies found that

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