DefinitionAmbulatory care sensitive (ACS) conditions refer to those conditions for which hospitalizations could have been avoided, or conditions that could have been less serious, if they had been treated early and appropriately. Good outpatient management dramatically reduces the risk of hospitalization. Bacterial pneumonia is a relatively common acute condition, treatable for the most part with antibiotics. If left untreated in susceptible individuals, such as the elderly, pneumonia can lead to death. For bacterial pneumonia, an ACS condition refers to bacterial pneumonia resulting in hospitalization. The risk-adjusted rate is the rate of hospitalizations of Utah residents of any age for bacterial pneumonia per 100,000 Utah population, adjusted for age and gender.
As of November 2004, the IBIS bacterial pneumonia indicator information is based on one indicator (PQI 11) developed by the Agency for Healthcare Research and Quality Prevention Quality Indicators. The Agency for Healthcare Research and Quality and Healthcare Cost and Utilization Project (HCUP) provide the values for the national rate.
NumeratorNumber of hospitalizations among adult Utah residents (age 18 years and older) with bacterial pneumonia as the principal diagnosis and excluding maternal, newborn, and transfer cases and cases with secondary diagnoses of sickle-cell anemia and HB-S disease.
DenominatorNumber of Utah residents aged 18 years and older.
Data Interpretation IssuesHigh admission rates may reflect a large number of inappropriate admissions or low-quality treatment with antibiotics. Admission for bacterial pneumonia is not a measure of hospital quality, but rather one measure of outpatient and other health care.
The Agency for Healthcare Research and Quality Prevention Quality Indicator for bacterial pneumonia includes hospitalized Utah adults of any age (18 years and older), and excludes cases that may result in over counting of bacterial pneumonia cases. Specific cases that are excluded are maternal cases, newborns, transfers from other institutions, and cases with secondary diagnoses of sickle-cell anemia and HB-S disease.
The Utah bacterial pneumonia rate is risk-adjusted by age and gender so that comparison with the national rate is more meaningful. 95% confidence intervals are the criterion for statistical significance, that is, they indicate whether differences are real or due to "noise" in the data.
Why Is This Important?Ambulatory care sensitive (ACS) conditions are conditions for which effective outpatient care can prevent hospitalizations. Outpatient care, including annual immunizations for influenza and pneumonia during the influenza season for at-risk people, can lessen the severity of bacterial pneumonia symptoms and prevent hospitalizations and death.
Other ObjectivesUtah's 42 Community Health Indicators
How Are We Doing?Based on this measure for available national data, Utah has had a significantly lower rate of hospitalizations due to bacterial pneumonia than the U.S. each year from 2006 through 2011 (the most recent available national data). Prior to this time frame, no clear trend exists.
How Do We Compare With the U.S.?Based on this measure for available national data, Utah has had a significantly lower rate of hospitalizations due to bacterial pneumonia than the U.S. each year from 2006 through 2011 (the most recent available national data). Prior to this time frame, no clear trend exists. In fact, Utah had a significantly higher rate of hospitalization due to bacterial pneumonia than the U.S. in 2003.
What Is Being Done?For patients at higher risk, two annual vaccinations can help prevent pneumonia. Pneumococcal vaccine is recommended for all immunocompetent individuals aged 65 years and older and for selected others at high risk. A pneumococcal conjugate vaccine is recommended for children.
Evidence-based PracticesAnnual influenza vaccines (flu shots) and pneumococcal vaccines, especially for individuals aged 65 years and older, have been shown to lower rates of bacterial pneumonia.
Health Program InformationUtah Immunization Program (http://www.immunize-utah.org/index.html)