EXHIBIT 4.
Averted hospitalizations for ambulatory care-sensitive conditions (ACSCs) and implied averted costs
| 2009–11 |
2012–14 |
All |
||||
|---|---|---|---|---|---|---|
| Number | 95% CI | Number | 95% CI | Number | 95% CI | |
| AVERTED HOSPITALIZATIONS | ||||||
| Inferences from all ACSCs combined | 3,146 | (1,078, 5,214) | 2,600 | (600, 4,600) | 5,746 | (1,679, 9,814) |
| Inferences from specific ACSCs | ||||||
| Congestive heart failure | 913 | (0 – 1,848) | 1,390 | (484, 2,295) | 2,303 | (460, 4,143) |
| Diabetes-related | 661 | (142 – 1,181) | 605 | (102, 1,108) | 1,266 | (243, 2,289) |
| Hypertension | 453 | (215 – 691) | 393 | (163, 623) | 846 | (377, 1,314) |
| Bacterial pneumonia | 1,125 | (179 – 2,072) | 214 | (0, 1,129) | 1,339 | (0, 3,201) |
| AVERAGE COST PER HOSPITALIZATION | ||||||
| Inferences from all ACSCs combined | $6,856 | — | $6,958 | — | $6,907 | — |
| Inferences from specific ACSCs | ||||||
| Congestive heart failure | 8,345 | — | 9,052 | — | 8,699 | — |
| Diabetes-related | 7,298 | — | 7,287 | — | 7,293 | — |
| Hypertension | 4,882 | — | 5,624 | — | 5,253 | — |
| Bacterial pneumonia | 6,573 | — | 6,409 | — | 6,491 | — |
| IMPLIED AVERTED COSTS (MILLIONS) | ||||||
| Inferences from all ACSCs combined | $21.6 | (7.4, 35.7) | $18.1 | (4.2, 32.0) | $39.7 | (11.6, 67.7) |
| Inferences from specific ACSCs | ||||||
| Congestive heart failure | 7.6 | (0.0, 15.4) | 12.6 | (4.4, 20.7) | 20.2 | (4.4, 36.1) |
| Diabetes-related | 4.8 | (1.0, 8.6) | 4.4 | (0.7, 8.1) | 9.2 | (1.7, 16.7) |
| Hypertension | 2.2 | (1.0, 3.3) | 2.2 | (0.9, 3.5) | 4.4 | (1.9, 6.8) |
| Bacterial pneumonia | 7.4 | (1.1, 13.6) | 1.3 | (0.0, 7.2) | 8.7 | (1.1, 20.8) |
SOURCE Authors’ analysis of data from the Ohio Hospital Association. NOTES Averted hospitalizations were calculated by applying the estimated reduction in hospitalization rates to the Cuyahoga County adult population size in each postintervention year. Costs per hospitalization reflect mean costs per hospitalization (of each type) for Cuyahoga residents in each post period. Costs of hospitalizations for ambulatory care-sensitive conditions (ACSC) adjusted for inflation (using the Consumer Price Index) to represent 2014 dollars. Confidence intervals (CIs) for averted cost estimates reflect uncertainty in hospitalization rate effect only and do account for uncertainty in mean cost per hospitalization.