One important way to assess health care access and quality is to examine the incidences of hospitalizations for conditions that are generally responsive to primary and preventive medical care.    Diabetes, for example, can often be handled with some combination of weight loss, dietary changes, and medication.  Through careful monitoring and proactive treatment, those with diabetes often can successfully manage their condition and thus avoid potentially serious complications.  On the other hand, those with diabetes who do not receive regular primary care may not receive treatment until their symptoms are so severe that they require hospitalization.  There are many conditions that are sensitive to preventive care; for example,  lung infections, adult asthma, high blood pressure, urinary tract infections, and diabetes.    In many cases, preventive care and early treatment can reduce the onset of certain illnesses, control an acute episodic occurrence of an illness, or help to manage a chronic medical condition.  Having to hospitalize people for conditions that would not have required it if early detection and preventive treatment had been provided not only threatens the health of patients, but adds enormously to overall healthcare costs.

The Preventive Quality Indicators (PQIs) are measurements of hospitalizations for diagnoses associated with preventive care sensitive conditions.  The PQIs utilize inpatient hospital records to establish admission and discharge rates for preventive care sensitive conditions.  Here we use thirteen indicators associated with adult hospitalizations:  short-term diabetes, perforated appendix, long-term diabetes, obstructive pulmonary disease, hypertension (high blood pressure), congestive heart failure, dehydration, bacterial pneumonia, urinary infections, angina without procedure, uncontrolled diabetes, adult asthma, lower extremity amputations (associated with diabetes).  We have combined the individual PQIs into a single scale that measures overall preventive care sensitive hospitalizations for each community on Long Island.

As the first chart indicates, the number of ACS hospitalizations has shown a slight decline from 2006 to 2010 (7%).  Between 2006 and 2009 the decline was only 2%.  However, there was a relatively drop between 2009 and 2010 of 5%. 
 
Many factors, both within and without the healthcare system, contribute to preventive care sensitive  hospitalizations.  Some of those include patients’ economic circumstances that limit their access to preventive healthcare, poor environmental conditions, limited community access to local healthcare facilities, and other factors associated with economic hardships.  As we saw with respect to perinatal risk factors, this is evident at the community level, as those communities with higher rates of Medicaid and uninsured hospitalizations tend to also have higher rates of PQI hospitalizations. There is a wide disparity across Long Island communities in the rates of preventive care sensitive hospitalizations.