Web-Based Tool Helps Plan High-Performing Health Care System
Joined by legislative and community partners, State Health Commissioner Richard F. Daines, M.D., today unveiled a new web-based tool that will be used to help plan a high-performing, affordable health care system with primary care as the centerpiece.
The new Prevention Quality Indicator (PQI) website is the first free, publicly accessible tool of its kind that identifies hospitalization rates by zip code level for conditions generally considered preventable with access to good primary care. It also reveals health disparities by breaking data down according to patients' race and ethnicity.
"As New York faces the worst fiscal crisis in a generation, it is imperative that we take the opportunity to reform our health care system to make it more efficient and affordable for all New Yorkers through greater access to primary care and preventive services," said Governor David A. Paterson. "This new website will be important as the State takes action toward reform, while additionally providing New Yorkers with access to data on preventable conditions in their communities such as diabetes, high blood pressure and asthma. This new prevention quality indicator website will help to better prepare New Yorkers in maintaining their health."
"Under Governor Paterson's leadership, we have begun critical reforms to improve health care access, quality and affordability," said Commissioner Daines. "While the Berger Commission was about restructuring facilities, our efforts going forward will focus on planning and shaping a system that better meets community needs. This website will provide the community level data we need to shape these efforts."
Despite being among the top three states in total per capita health care spending, New York ranks 39th among states for hospital admissions for preventable conditions. "This doesn't mean New York's hospitals are doing a bad job; on the contrary, our hospitals are providing excellent acute care," said Dr. Daines. "What it means is that too many New Yorkers are not getting effective primary care to prevent, detect and treat conditions before they become serious and require hospitalization."
The website provides hospital admission rates for the following four areas and 12 conditions based on measures developed by the federal Agency for Healthcare Research and Quality (AHRQ):
* Circulatory Conditions:
o Congestive Heart Failure
* Diabetes-Related Conditions:
o Short-term Complications
o Long-term Complications
o Lower Extremity Amputation
o Uncontrolled Diabetes
* Respiratory Conditions:
o Chronic Obstructive Pulmonary Disease (COPD)
* Acute Conditions:
o Bacterial Pneumonia
o Urinary Tract Infection
Health planners, advocates, and the general public will be able to use the PQI data to identify gaps in needed services in their communities and strengthen local health care planning.
"Despite facing very difficult fiscal challenges, with Governor Paterson's support we are moving forward with reforms that strengthen and improve New York's health care system," said State Assemblyman Richard N. Gottfried, chair of the Assembly Health Committee. "Improving health requires that more New Yorkers receive prevention and health education that encourage them to live a healthy lifestyle and better manage chronic conditions to avoid serious complications that require hospitalization."
"Ultimately, greater utilization of primary care not only will lead to better health for New Yorkers but also a more affordable health care system by reducing the number of expensive hospital stays that could have been avoided had patients received good primary care earlier in their lives," said State Senator Kemp Hannon, chair of the Senate health Committee.
"Local health departments and hospitals are partnering to develop joint Community Health Assessments and Service Plans," said James B. Crucetti, M.D., M.P.H., Albany County Commissioner of Health. "The PQI data will provide invaluable zip-code level information that will enhance these collaborative efforts. Moreover, these measures of potentially preventable conditions can have a very positive impact on promoting the health of our communities."
"Governor Paterson's health reforms will help increase access to the kind of primary care New Yorkers need to improve their health," said Acklema Mohammad, M.D., Director of Pediatrics for the Urban Health Plan community health center in the Bronx. "The PQI website will help us identify communities where there are high rates of hospitalizations for conditions we could prevent if we could get these individuals into primary care."
"The mission of New York's hospitals is to ensure that the health and well-being of communities is protected," said Sue Ellen Wagner, Vice President, Community Health, Healthcare Association of New York State. "Whether it be through the life-saving care provided within a hospital or through the vital services delivered in outreach or prevention programs, it's critical that patients are able to receive the right care in the right setting. The PQI website will enable members of the public and health care providers to gain valuable insight and information, assess where greatest need for services exist, and foster a collaborative approach to improving access to much needed primary and preventive services."
"The PQI data reveal racial and ethnic disparities in basic measures of health care," said Anne C. Beal, Assistant Vice President of the Commonwealth Fund and chair of the state Minority Health Council, an advisory group to the State Health Department. "Our challenge now is use this information effectively to target efforts that expand access to high quality primary care and better chronic disease management to communities, racial and ethnic groups with disproportionately higher rates of hospitalizations for preventable conditions."
For example, a review of PQI data by race and ethnicity in the Morningside Heights neighborhood of Manhattan in zip codes 10025, 10026 and 10027, illustrates wide disparities. The overall PQI rate for the 12 conditions for African Americans is double the expected statewide rate and about 1.6 times higher for Hispanics, while Whites were hospitalized for these conditions at less than half the overall rate.
The downtown Brooklyn zip codes of 11201, 11205 and 11217 reveal admission rates for uncontrolled diabetes that are more than two-and-a-half times statewide norms, with admission rates for African Americans and Hispanics nearly five times the statewide rate.
In Western New York, the south Buffalo zip codes of 14201, 14202, 14203 and 14204 have total PQI hospitalization rates about 50 percent higher than the expected statewide rate. Hospital admission rates for diabetes are more than double the statewide rate.
In the rural central Delaware County zip codes of 13731, 13740, 13752, 13753 and 12455, the overall PQI hospitalization rate is 30 percent below statewide norms. But just to the north near the Delaware-Schoharie county border, the hospitalization rate for potentially preventable hospitalizations is about 37 percent higher than the state average.
The Albany zip codes of 12202, 12204, 12207 and 12210 show hospitalization rates for complications from diabetes that are 57 percent higher than the statewide rate.
"The PQI data will inform our health care planning at both the state and local levels," said James W. Clyne, Deputy Commissioner of the State Health Department's Office of Health Systems Management. "As the department considers requests from health care providers to deploy new equipment or establish new health care services, we are going to ask all interested parties to consider the portrait of community needs and issues suggested by these Prevention Quality Indicators."
In the future the Health Department plans to expand the number and kinds of measures in the PQI database, including preventable childhood hospitalization rates for conditions such as asthma.
The use of Prevention Quality Indicators for health planning purposes is one of several efforts under Governor Paterson to expand New Yorkers' access to primary care. Other initiatives include the creation of a new Doctors Across New York program that provides financial incentives to doctors to practice in underserved areas and shifting some Medicaid funding from hospital inpatient care to outpatient and primary care services.