Prevention is an important role for all health care providers. Providers can help individuals stay healthy by preventing disease, and they can prevent complications of existing disease by helping patients live with their illnesses. To fulfill this role, however, providers need data on the impact of their services and the opportunity to compare these data over time or across communities. Local, State, and Federal policymakers also need these tools and data to identify potential access or quality-of-care problems related to prevention, to plan specific interventions, and to evaluate how well these interventions meet the goals of preventing illness and disability.
While these indicators use hospital inpatient data, their focus is an outpatient health care. Except in the case of patients who are readmitted soon after discharge from a hospital, the quality of inpatient care is unlikely to be a significant determinant of admission rates for ambulatory care sensitive conditions. Rather, the Prevention Quality Indicators (PQIs) assess the quality of the health care system as a whole, and especially the quality of ambulatory care, in preventing medical complications. As a result, these measures are likely to be of the greatest value when calculated at the population level and when used by public health groups, State data organizations, and other organizations concerned with the health of populations.
These indicators* serve as a screening tool rather than as definitive measures of quality problems. They can provide initial information about potential problems in the community that may require further, more in-depth analysis.
Congestive heart failure (CHF) can be controlled in an outpatient setting for the most part; however, the disease is a chronic progressive disorder for which some hospitalizations are appropriate.
Proper outpatient treatment may reduce admissions for CHF.
*The following caveats were identified from the literature review for the "Congestive Heart Failure Admission Rate" indicator:
- Proxya: Indicator does not directly measure patient outcomes but an aspect of care that is associated with the outcome; thus, it is best used with other indicators that measure similar aspects of care.
- Easily manipulateda: Use of the indicator may create perverse incentives to improve performance on the indicator without truly improving quality of care.
- Unclear benchmarkb: The "correct rate" has not been established for the indicator; national, regional, or peer group averages may be the best benchmark available.
Refer to the original measure documentation for further details.
Note:
a - The concern is theoretical or suggested, but no specific evidence was found in the literature.
b - Indicates that the concern has been demonstrated in the literature.
