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Prevention Quality IndicatorsPrevention Quality Indicators (PQIs) developed by the Agency for Healthcare Research and Quality[1] identify and measure conditions for which good outpatient care can potentially prevent hospitalization. The PQIs assess the healthcare system as a whole, and especially the quality of outpatient care in preventing medical complications.
The PQIs are population-based and rates are presented at the county-level. Examining rates for a single year provides a snapshot view into the community for each condition. Trending these indicators over time allows assessment of whether observed differences are likely the result of normal variation (i.e., rates differ from average in a single year) or reflect a pattern (i.e., rates differ from average for longer periods of time). This longitudinal perspective may lead to the identification of areas that serve as a model of excellence or areas with unmet healthcare needs. Addressing these needs, and providing effective and timely outpatient care, may help to avoid serious complications and use of costly resources such as hospitalization.
General Findings
The addition of the 2007 data to the PQIs revealed the following trends: - The statewide rate for Vermont for 8 of the 14 PQI conditions has been considerably lower than the national rate since 2002
- The rate of admission for almost all PQIs has been stable in Vermont since 2002
- The rate of admission for angina (without procedure) has been decreasing since 2002
- The rate of admission for urinary tract infections has been gradually increasing since 2003
Many of the differences observed between 2006 and 2007 can be attributed to a change in the data set used for the analysis. In 2007, the data set includes Vermont residents hospitalized out-of-state. Prior to 2007, out-of-state hospitalizations were not available. This change in data will have noticeable impact on the county-level rates, particularly for the eastern counties bordering with New Hampshire, and enhances this report allowing for a more accurate depiction of utilization and quality of care provided to Vermonters.
Recommendations
With minor exceptions, the rates of admission for the PQI conditions in Vermont have been stable since 2002. This is positive in that the rates have not increased, but also indicates that focused efforts have not taken place, or have not been effective, to reduce these admissions. The chapter on chronic illness in this year’s Quality Report emphasizes the importance of preventive care to minimize costly hospitalizations. The PQI results suggest that more can be done to focus on preventative care, at least for the 14 indicators considered in this report.
It is also recommended that the admission rates comparison between Vermont counties continue to be tracked. Comparison of the 2007 distribution to previous years is not useful because data for Vermonters hospitalized out-of-state was not available prior to 2007. Further tracking will be necessary to identify trends.
Prevention Quality Indicator Measure-specific Findings
Uncontrolled Diabetes Admission Rate
Diabetes Short-term Complication Admission Rate
Diabetes Long-term Complication Admission Rate
Rate of Lower-extremity Amputation among Patients with Diabetes
Chronic Obstructive Pulmonary Disease Admission Rate
Adult Asthma Admission Rate
Hypertension Admission Rate
Congestive Heart Failure Admission Rate
Dehydration Admission Rate
Bacterial Pneumonia Admission Rate
Urinary Tract Infection Admission Rate
Angina without Procedure Admission Rate
Perforated Appendix Admission Rate
Low Birth Weight Rate
Data and Methodology
The AHRQ indicators use administrative hospital discharge data as a window into the delivery of medical care. These data, which are collected as a routine step in the delivery of hospital services, provide information on diagnoses, procedures, age, gender, admission source, and discharge status. Although administrative data alone cannot provide a complete assessment of quality, they can be used to identify potential quality problems or “flag” areas of excellence which can then be further investigated and studied, either to address needed improvements or to assist adaption of excellence at other facilities or in other communities.
The 2009 Quality Report presents analyses of hospital discharge data from 2002 - 2007. This extends and updates the measures reported in last year’s Quality Report. Incorporating the additional year of data (2007) allows further examination of trends, and unlike previous years, the 2007 data includes Vermonters treated at out-of-state hospitals in New Hampshire, New York, and Massachusetts, as well as patients treated in-state. As such, county-level indicators present services provided to Vermonters (regardless of hospital).
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