Hospitalization for Potentially Preventable Complications (HPC)

For persons 67 years of age and older, the rate of discharges for ambulatory care sensitive conditions (ACSC) per 1,000 persons and the risk-adjusted ratio of observed-to-expected discharges for ACSC by chronic and acute conditions.

Why it Matters

Ambulatory care sensitive conditions are acute and chronic health conditions that can be managed or treated in the outpatient setting.

Appropriate access to care, high-quality care coordination, a focus on chronic disease self-management and connection to community resources can reduce the probability that individuals with these chronic and acute conditions will develop complications or exacerbations that result in hospitalization.

Hospital and inpatient care accounts for a large component of total health care costs for older adults (41% of Medicare spending, approximately $303B dollars in 2018) ⁽¹⁾. Hospitalization also poses several risks for older adults, who frequently develop serious conditions as a result of hospitalization such as delirium, infection and decline in functional ability ^(2,3).

Reducing the rate of hospitalization for potentially preventable complications of acute and chronic conditions for older adults will improve patient health, reduce costs and improve quality of life. It is important to note that some complications or exacerbations are unavoidable and therefore the appropriate rate of hospitalization is not “zero”; however, this measure will provide important information to health plans, providers and consumers and other stakeholders about how well a system of care helps older adults with chronic and acute conditions prevent hospitalization.

* Adapted with financial support from CMS and with permission from the measure developer, the Agency for Healthcare Research and Quality (AHRQ).

Historical Results – National Averages

Performance results for this measure are currently unavailable.
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References

Kaiser Family Foundation (KFF). The Facts on Medicare Spending and Financing. https://www.kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/ (Accessed March 25, 2020)
Gillick, M.R., N.A. Serrell, and L.S. Gillick. 1982. “Adverse Consequences of Hospitalization in the Elderly.” Social Science & Medicine 16(10), 1033–8.
Covinsky, K.E., E. Pierluissi, & C.B. Johnston. 2011. “Hospitalization-Associated Disability.” JAMA: The Journal of the American Medical Association,306(16): 1782–93.