The household income of its residents is the most important factor in whether a community has high or low rates of avoidable hospital visits conditions that could be better managed in a doctors office or other healthcare settings if treated at an early stage, according to a report by the Rutgers Center for State Health Policy in New Brunswick, N.J.
An analysis of hospital billing records and demographic data by Rutgers researchers across 13 low-income communities in New Jersey found that as an areas per capita income rises, the number of patients who seek medical care in the hospital falls dramatically, according to a news release. A 1% increase in local area per capita income was associated with a 0.85% decrease in avoidable hospitalizations.
The Rutgers team also discovered that hospital systems in some low-income areas perform better than one would expect given their per capita income and other socioeconomic disadvantages.
For example, Camden, an area that is known for high rates of avoidable hospital visits, performs better than expected after statistically adjusting for the citys high level of socioeconomic disadvantage, according to the researchers. In contrast, high rates of avoidable visits in Jersey City and Asbury Park changed little after socioeconomic adjustments. This suggests that avoidable hospitalizations in these places are most likely related to factors other than income such as the lack of access to primary care doctors.
The report was funded by The Nicholson Foundation as part of its effort to improve the quality and affordability of healthcare in New Jerseys underserved communities. It can help policymakers and healthcare providers understand variations in hospital use so they can design strategies to limit avoidable hospitalizations, according to the release.
The findings show how well a hospital system can perform in the face of poverty, Rachel Cahill, director of healthcare improvement and transformation at The Nicholson Foundation, said in the release. The fact that some low-income areas are performing well despite their dire situations indicates that there is great potential for improvement.
Cahill said the report has important policy implications as New Jersey begins to implement its three-year Medicaid Accountable Care Organization pilot, a demonstration project to improve the quality and affordability of care in low-income regions.
In many low-income communities, lowering avoidable hospital use and cost requires emphasis on the social determinants of health, the reports lead author, Derek DeLia, associate research professor at the CSHP, said in the release. This is especially true in communities that perform better than expected after adjusting for socioeconomic factors. In these communities, interventions that give special consideration to the daily stresses and problems associated with poverty such as unsafe neighborhoods, unstable housing, lack of transportation or limited access to healthy foods can play a greater role in improving health and reducing avoidable medical episodes than a purely medical care focus.
The researchers focused on the records of patients with conditions such as asthma, pneumonia, chronic pulmonary obstructive disease and congestive heart failure because these are conditions for which hospitalization is often preventable when access to primary care is adequate.