Preventable Hospitalizations Among Children in Los Angeles County and the Impact of the CHI

LOS ANGELES HEALTHY KIDS EVALUATION HTTP://COMMUNITYHEALTH.USC.EDU April 2009 PREVENTABLE HOSPITALIZATIONS AMONG CHILDREN IN LOS ANGELES COUNTY AND THE IMPACT OF THE CHI MICHAEL R. COUSINEAU, ALBERT J. FARIAS, TREVOR PICKERING It is widely known that improving access to ambulatory care helps prevent hospitalizations for certain conditions, deemed ambulatory care sensitive conditions. These include chronic common conditions such as asthma, diabetes and ailments such as pneumonia, urinary tract infections, and gastroenteritis. The Children’s Health Initiative of Greater Los Angeles (CHI) formed in order to improve children’s access to primary care by increasing enrollment into Medi-Cal and Healthy Families, and expanding coverage via the locally funded Healthy Kids programs which is designed to provide coverage for low-income uninsured children ineligible for other programs. Previous reports showed that the Children’s Health Initiatives reduced the overall rate of preventable hospitalizations in low-income children.1 In this study we ask: Did the CHI in Los Angeles similarly reduce preventable hospitalizations for low income children in Los Angeles County? We analyzed hospitalization rates overall in Los Angeles for lower income compared to higher income children. We similarly calculated rates for hospitalizations for ambulatory care sensitive conditions. Table 1: Rates of Hospitalizations (per 10,000) among children in Los Angeles County, 2000-2007 Total Hospitalizations Total High Income Low Income Number Rates per 10,000 Number Rates per 10,000 Number Rates per 10,000 2000 223231 209.1 98196 223.6 125035 199.0 2001 219515 205.0 93173 209.0 126342 202.2 2003 218850 203.8 89650 198.1 129200 208.0 2003 216916 201.8 87129 190.6 129787 210.2 2004 212494 198.3 83269 180.7 129225 211.6 2005 211059 198.6 83045 180.9 128014 211.9 2006 209343 199.4 82781 184.7 126562 210.5 2007 206040 199.1 81259 186.3 124781 208.4  Hospitalization rates in Los Angeles County are low compared to national averages. Hospitalizations for children are infrequent events. National data show hospitalization rates of 378 hospitalizations per 10,000 children.2 Hospitalizations are less common in Los Angeles County, which are on average of 200 per 10,000 children are hospitalized each year. The rate has been declining steadily as seen between 2000 and 2007, the rates changed from 209 to 199 per 10,000 (Table 1). Hospitalization rates are declining for children in high income groups while there was generally little or no change among lower income children. Overall, rates of hospitalization are approximately 10 percent higher among poor children, compared to higher income children. Table 2: Rates of Preventable Hospitalizations (per 10,000) among children in Los Angeles County, 2000-2007. Preventable Hospitalizations Total High Income Low Income Number Rates per 10,000 Number Rates per 10,000 Number Rates per 10,000 2000 15418 14.4 6298 14.3 9120 14.5 2001 14783 13.8 5965 13.4 8818 14.1 2002 16017 14.9 6063 13.4 9954 16.0 2003 14341 13.3 5139 11.2 9202 14.9 2004 13878 13.0 4809 10.4 9069 14.9 2005 13980 13.2 4767 10.4 9213 15.3 2006 13324 12.7 4629 10.3 8695 14.5 2007 11179 10.8 3702 8.5 7477 12.5  Preventable hospitalizations in Los Angeles County are steadily declining. Table 2 shows the rates of preventable hospitalizations (e.g. 2000 had a rate of 14 per 10,000 and 2007 had a rate of 11 per 10,000). Overall, rates steadily declined for high income children; for low income children, we note some fluctuation in the rate. The rate was 16 per 10,000 in 2003, and dropped to 12.5 per 10,000 in 200