Hospitalization Rates for Ambulatory Care-Sensitive Conditions in California Medicare HMO's

Published In: Journal of Clinical Outcomes Management, v. 12, no. 11, Nov. 2005, p. 559-562, 566-568

Posted on on January 01, 2005

by Feng Zeng, June O'Leary, Elizabeth M. Sloss, Nasreen Dhanani, Glenn Melnick

Read More

Access further information on this document at

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVE: To examine annual hospitalization rates for ambulatory care-sensitive conditions (ACSCs) among Medicare HMO beneficiaries. DESIGN: Cross-sectional descriptive study. Setting and participants: Medicare beneficiaries aged 65 years and older continuously enrolled in 1 of 15 California Medicare HMOs from 1 January through 31 December 2001. MEASUREMENTS: Hospitalization rates overall and for each of 15 ACSCs (bacterial pneumonia, cellulitis, dehydration, gastric and duodenal ulcer, hypoglycemia, hypokalemia, severe ear/nose/throat infections, urinary tract infections, asthma/chronic obstructive pulmonary disease, congestive heart failure, diabetes, hypertension, seizure disorder, influenza, and malnutrition). The rate for the 15 ACSCs combined as well as acute, chronic, and preventable indices were also estimated. RESULTS: Of the 1.2 million Medicare beneficiaries enrolled in California HMOs during 2001, 24% were 80 years or older (range among plans, 15%-34%), 5% were African American (range, 1%-25%), and 6% were Medicaid-eligible (range, 3%-16%). Enrollees experienced a total of 315,503 hospitalizations in 2001 (267 per 1000), 22% of which were for an ACSC. ACSC hospitalization rates varied widely by plan and were higher among older enrollees, males, and those eligible for Medicaid. CONCLUSION: ACSC hospitalization rates are easy to calculate based on administrative data. These rates can be used by individual plans as a method to screen for possible access and quality of care problems.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.