Hospitalization for Potentially Preventable Complications (HPC)

Assesses the rate of hospital inpatient admissions and observation stays due to complications of ambulatory care-sensitive conditions (ACSC) among Medicare (67 and older) health plan members. Separate hospitalization rates for chronic and acute ACSCs are reported for members. As well as reporting observed rates, NCQA also specifies that plans report an expected count of hospitalizations, predicted using members’ prior and current health, among other factors. The observed event count and the expected event count are used to calculate a calibrated observed-to-expected (O/E) ratio that assesses whether plans had more, the same or fewer hospitalizations than predicted by their case mix, while accounting for incremental improvements across all plans over time. An O/E ratio below 1 indicates better-than-average performance and an O/E ratio above 1 indicates worse-than-average performance.

Why it Matters

ACSCs can be acute (bacterial pneumonia, cellulitis, urinary tract infection, pressure ulcer) or chronic (diabetes, COPD, asthma, hypertension, heart failure) and can be managed or treated in an outpatient setting. Hospital stays account for a large component of total health care costs for older adults and pose several risks, such as delirium, infection and decline in functional ability.^1,2,3 Hospitalizations for exacerbations of ACSC can be prevented with appropriate access to ambulatory care services, timely delivery of care and high-quality care coordination. Reducing the rate of hospitalization for older adults will improve patient health, reduce costs and improve quality of life.

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.