I am pleased to announce that A Common Denominator: Calculating Hospitalization Rates for Ambulatory Care–Sensitive Conditions in California by Camillia K. Lui and Steven P. Wallace is the winner of the first annual Preventing Chronic Disease (PCD) Student Research Contest. Ms Lui is a fourth-year doctoral student at the University of California, Los Angeles, in the Department of Community Health Sciences. Her advisor is Dr Steven Wallace.
PCD is dedicated to being the venue for sharing advances in public health research, practice, and policy, and we are committed to the development of young public health professionals as part of this effort. To this end, we have instituted the Student Research Contest as a way to engage students in the publication process and recognize the outstanding work of the next generation of the public health workforce. In July 2010, we announced our first annual call for student papers and reached out to multiple partners to distribute the call and encourage students to submit their work to PCD.
Papers were due in January 2011, and we received submissions on a range of topics from institutions throughout the United States. In February and March, a small team of editorial board members (Drs Bowman, Brownson, Lengerich, and Remington), PCD’s founding editor (Dr Lynne Wilcox), and I reviewed the submitted manuscripts. In March we selected the paper by Ms Lui and Dr Wallace as the winner.
Lui and Wallace examined the prevalence, hospitalization rates, and geographic variability of hypertension and congestive heart failure, 2 chronic health conditions that are considered to be manageable with effective outpatient treatment (ie, ambulatory care–sensitive conditions), in California. Their analysis makes use of 2 large datasets, the California Health Interview Survey (www.chis.ucla.edu/) and hospital patient discharge files of the California Office of Statewide Health Planning and Development (www.oshpd.ca.gov/). This analysis is important to health care resource planning because it uses the population at risk rather than the total population in calculating hospitalization rates.
With these 2 common conditions, 2 different scenarios emerged. In the case of hypertension, approximately 74% of the geographic areas did not change in ranked quintile when comparing age and age/disease prevalence rates, which suggests that resources are meeting the needs of the at-risk population. However, in the case of congestive heart failure, 31 of the 55 geographic areas in California changed quintile rank — approximately 72% by 2 or more ranks. In this case, the geographic distribution of the population at risk does not mirror that of the general population. This finding has implications for planning and targeting public health programs and health care services in areas where the population at risk resides.
As with any analysis that uses administrative and self-reported data, this study has limitations, and the results do not identify the one area that should be changed to inform policy and programs to reduce health care spending and rates of illness and death. This analysis is thoughtful and identifies several issues that need further investigation. What are the reasons for increased rates of age/risk-adjusted hospitalizations in some geographic areas? Are these observed differences a function of demographic, economic, geographic, or access factors? What are the interventions needed to ensure that people receive adequate and appropriate care? This analysis demonstrates the need to consider disease prevalence when examining hospitalization rates and that, depending on the condition, resources may need to be redistributed.
Congratulations to Ms Lui on winning the first annual PCD Student Research Contest. Several outstanding papers were submitted, and the decision was not an easy one. We thank all of the students who submitted papers for this contest and recognize the hard work that goes into publishing scientific work. Please listen to the short podcast with Ms Lui to hear her discuss her article. Manuscripts for the second annual PCD Student Research Contest are now being accepted, and the winning manuscript will be published in 2012.