New Jersey Hospital Association Study Raises Red Flags Over Healthcare Access; Data Shows Poor Are Hospitalized More Often for Avoidable Conditions.

Business Editors

PRINCETON, N.J.--(BUSINESS WIRE)--March 28, 2001

A new study by the research division of the New Jersey Hospital Association suggests that too many people end up hospitalized for conditions that could be managed on an outpatient basis.

That finding raises a red flag concerning New Jerseyans' access to primary healthcare, especially in poorer communities.

The study, "Access to Primary Care in New Jersey: Geographic Variation of Hospitalizations for Ambulatory Care Sensitive Conditions in 1995 and 1997," was launched in 1998 with $180,000 in grant funding from the Robert Wood Johnson Foundation. Its purpose? To identify avoidable hospital admissions where timely and effective outpatient treatment could improve care for patients and reduce costs to the healthcare system.

Conducted by the Health Research and Educational Trust of New Jersey, the study found that the admission rate for so-called ambulatory care sensitive conditions (which include generally treatable conditions such as asthma, bacterial pneumonia and diabetes) was 13.6 per 1,000 residents in 1997. That rate rose substantially in low-income areas. Nine counties reported hospitalization rates higher than the state average, led by Essex (22.6), Hudson (22.0) and Passaic (16.2)

The three leading causes for these preventable admissions were asthma, bacterial pneumonia and congestive heart failure, according to the study.

On a brighter note, the report found significant improvement in the hospitalization rates for these conditions between 1995 and 1997. The data showed a 12 percent decline in the hospitalization rate between these two benchmark years.

Just what the findings mean must be subject to more research, the study's author says. But NJHA President and CEO Gary Carter said the report creates an important starting point for analysis that will ultimately improve patients' access to primary healthcare and reduce costs to the system.

"Access to primary healthcare is an important issue with significant ramifications, both in terms of our residents' well-being and costs to the entire healthcare system," Carter said. "This study provides a first-time snapshot look at where we stand. And it's telling us that we need to do a better job of reaching these patients early, through good preventive and follow-up outpatient care."

The study collected data on both children and adults under age 65 from the state's Uniform Bill Patient Summary, often called UB-92 data. The data was broken down to county and zip code levels to conduct further analysis.

Previous studies by John Billings, director of the Center for Health and Public Service Research at New York University, show New Jersey's hospitalization rates for ACS conditions highest among 10 states analyzed. Billings also served as an adviser to NJHA's study.

Among the probable causes for New Jersey's elevated rates, Billings said, are physician practice patterns that rely more on inpatient treatment, New Jersey's old rate-setting system that did not encourage development of outpatient services and deficiencies in the state's outpatient delivery system for the indigent.

Dr. Firoozeh Vali, NJHA's director of research and the study's principal investigator, said the data and analysis will be useful in improving outpatient healthcare services, especially for at-risk populations.

"We now have hard data showing us that these populations face the greatest barriers to accessing care in the proper settings," said Vali.

Those barriers may include a number of factors such as lack of health insurance, lack of transportation, inconvenient locations for clinics and physicians' offices, long appointment and office wait times, language barriers and lack of cultural sensitivity, Vali said.

The study offers a number of recommendations to address such problems, including:

-- Design multidisciplinary clinics that allow children and adults to be seen
at the same setting.

-- Add more non-English-speaking staff to hospital clinics and other primary
care settings.

-- Use nurse practitioners or physician assistants to expand office hours,
including evening and weekend hours.

-- Offer more appointment slots - including same-day appointments

- to reduce waiting times.

-- Create more convenient primary care settings such as mobile

units and neighborhood- and work-based clinics.