Preventable Hospitalization

The Centers for Disease Control defines potentially preventable hospitalizations as “admissions to a hospital for certain acute illnesses (e.g., dehydration) or worsening chronic conditions (e.g., diabetes) that might not have required hospitalization had these conditions been managed successfully by primary care providers in outpatient settings. Although not all such hospitalizations can be avoided, admission rates in populations and communities can vary depending on access to primary care, care-seeking behaviors, and the quality of care available.” This indicator expands on the chronic disease emergency room visits to include acute illnesses and those children and adults admitted to the hospital for their presenting condition. Across the St. Louis region, over 20,000 preventable hospitalizations occurred in 2015.

Preventable Hospitalization Indicator Scores

City of
St. Louis

34

St. Louis
County

35

St. Charles
County

58

St. Clair
County

38

Data Source: Missouri Department of Health and Senior Services, MOPHIMS, 2015

Data Note: The specific diagnoses included by MOPHIMS in preventable hospitalization are angina, asthma, bacterial pneumonia, cellulitis, chronic obstructive pulmonary, congenital syphilis, congestive heart failure, convulsions, dehydration-volume depletion, dental conditions, diabetes, epilepsy, failure to thrive, gastroenteritis, hypertension, hypoglycemia, immunization-preventable, kidney-urinary infection, nutritional deficiencies, pelvic inflammatory disease, severe ENT infection, tuberculosis.

What does this score mean?

A score of 100 represents racial equity, meaning there are no racial disparities in the outcomes between black and white populations. The lower the Equity Score, the greater the disparity.

For Preventable Hospitalization, a score of 100 – a score reflecting racial equity – would mean black and white residents have an equal likelihood of being admitted to a hospital for an acute illness or chronic condition that could have been prevented with access to better health care. It is important to note that for this indicator, equity is not our only goal; we also want to improve outcomes for all.

WHAT DOES THIS ANALYSIS MEAN?

Black residents in the City of St. Louis and in St. Louis County are nearly three times as likely as white residents to be admitted to a hospital for an acute illness or for a chronic disease that could have been prevented with access to equitable health care. Black residents in St. Charles County are 1.5 times as likely as white residents to be admitted to a hospital for a preventable condition. Data on preventable hospitalization by race were not available for St. Clair County.

If preventable hospitalization outcomes were more equitable, the number of black residents experiencing preventable hospitalizations would have been:

  • 2,918 fewer in the City of St. Louis,
  • 80 fewer in St. Charles County, and
  • 3,449 fewer in St. Louis County.

Why Does Preventable Hospitalizations Matter?

Preventable hospitalizations have an impact both on the individual and on the community. For a child, a preventable hospitalization means time out of school that could have been avoided by access to better health care. For adults, it means time off work, which impacts not only the individual’s household income, but also creates a productivity gap for the individual’s employer.

In addition, preventable hospitalizations create an unnecessary cost for insurance, whether public or private, to cover. For those children and adults admitted to the hospital who do not have insurance coverage, it creates an unnecessary cost burden on the hospital.

Which Calls to Action from the Ferguson Commission’s report are linked with this indicator?

The Ferguson Commission’s calls to action intended to reduce the incidence of preventable hospitalization include:

Questions for Further Investigation:

  • Why is there a racial disparity in Preventable Hospitalizations?
  • What can St. Louis do to reduce racial disparities in Preventable Hospitalizations?
  • What initiatives are currently underway to reduce racial disparities in Preventable Hospitalizations?

How can I learn more about this issue?

In 2015, For the Sake of All, a Washington University in St. Louis-based initiative now known as Health Equity Works, published a report on the health and well-being of African Americans in St. Louis.

Preventable Hospitalizations Data

Age-adjusted rate of preventable hospitalizations per 10,000 residents

 AllBlackWhiteDisparity RatioEquity Score
Number of Hospitalizations
6,3134,4521,667
Population Under 65
297,208139,234151,298
Rate of Preventable Hospitalizations per 10,000 Residents
212.41319.75110.182.90234

Data Source: Missouri Department of Health and Senior Services, MOPHIMS, 2015

Age-adjusted rate of preventable hospitalizations per 10,000 residents

 AllBlackWhiteDisparity RatioEquity Score
Number of Hospitalizations
11,4555,3335,692
Population Under 65
912,676218,781661,092
Rate of Preventable Hospitalizations per 10,000 Residents
125.51243.7686.12.83135

Data Source: Missouri Department of Health and Senior Services, MOPHIMS, 2015

Age-adjusted rate of preventable hospitalizations per 10,000 residents

 AllBlackWhiteDisparity RatioEquity Score
Number of Hospitalizations
2,9902212,641
Population Under 65
357,31417,586328,974
Rate of Preventable Hospitalizations per 10,000 Residents
83.68125.6780.281.56558

Data Source: Missouri Department of Health and Senior Services, MOPHIMS, 2015

Age-adjusted rate of preventable hospitalizations per 10,000 residents

 AllBlackWhiteDisparity RatioEquity Score
Number of Hospitalizations
71,23033,97028,868
Population Under 65
265,72974,435149,149
Rate of Preventable Hospitalizations per 10,000 Residents
2,680.554,563.711,935.512.35838

Data Source: Illinois Department of Public Health IQuery, 2014