Development and Validation of the Agency for Healthcare Research and Quality Measures of Potentially Preventable Emergency Department (ED) Visits: The ED Prevention Quality Indicators for General Health Conditions

Health Serv Res. 2017 Oct;52(5):1667-1684. doi: 10.1111/1475-6773.12687. Epub 2017 Mar 30.

Abstract

Objective: To develop and validate rates of potentially preventable emergency department (ED) visits as indicators of community health.

Data sources: Agency for Healthcare Research and Quality, Healthcare Cost and Utilization Project 2008-2010 State Inpatient Databases and State Emergency Department Databases.

Study design: Empirical analyses and structured panel reviews.

Methods: Panels of 14-17 clinicians and end users evaluated a set of ED Prevention Quality Indicators (PQIs) using a Modified Delphi process. Empirical analyses included assessing variation in ED PQI rates across counties and sensitivity of those rates to county-level poverty, uninsurance, and density of primary care physicians (PCPs).

Principal findings: ED PQI rates varied widely across U.S. communities. Indicator rates were significantly associated with county-level poverty, median income, Medicaid insurance, and levels of uninsurance. A few indicators were significantly associated with PCP density, with higher rates in areas with greater density. A clinical and an end-user panel separately rated the indicators as having strong face validity for most uses evaluated.

Conclusions: The ED PQIs have undergone initial validation as indicators of community health with potential for use in public reporting, population health improvement, and research.

Keywords: Emergency department; ambulatory care sensitive conditions; community health; quality indicators.

MeSH terms

  • Acute Disease
  • Age Factors
  • Asthma / diagnosis
  • Asthma / therapy
  • Back Pain / diagnosis
  • Back Pain / therapy
  • Chronic Disease
  • Emergency Service, Hospital / statistics & numerical data*
  • Health Services Research
  • Humans
  • Medicaid
  • Medically Uninsured
  • Poverty
  • Public Health*
  • Quality Indicators, Health Care / standards*
  • Sex Factors
  • Stomatognathic Diseases / diagnosis
  • Stomatognathic Diseases / therapy
  • United States
  • United States Agency for Healthcare Research and Quality / standards*