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Are Smoking and Alcohol Misuse Associated with Subsequent Hospitalizations for Ambulatory Care Sensitive Conditions?

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Abstract

Hospitalizations for ambulatory care sensitive conditions (ACSCs) are used to assess quality of care, but studies rarely adjust for health behaviors. This study evaluated whether results of smoking or alcohol screening were associated with hospitalizations for ACSCs. Participants included 33,273 male Veterans Affairs general medicine outpatients who returned mailed surveys. The main outcome was hospitalization with a primary discharge diagnosis for an ACSC in the year following screening. Analyses were adjusted for demographics, comorbidity, and other health behaviors. Current and previous smoking and abstaining from alcohol were associated with significantly increased risk of hospitalization for ACSCs, but alcohol misuse was not. However, severe alcohol misuse was associated with increased risk of hospitalizations with a primary or secondary ACSC discharge diagnosis. When ACSCs are used to evaluate the quality of care, health systems caring for populations with higher rates of smoking or nondrinking could falsely appear to have poorer quality care if alcohol and tobacco use are not considered.

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References

  1. Institute of Medicine. Crossing the Quality Chasm: A New System for the 21st Century. Washington, D.C.: National Academy Press; 2001.

    Google Scholar 

  2. Billings J, Anderson GM, Newman LS. Recent findings on preventable hospitalizations. Health Affairs. Fall 1996;15(3):239–249.

    Article  CAS  PubMed  Google Scholar 

  3. Billings J, Zeitel L, Lukomnik J, et al. Impact of socioeconomic status on hospital use in New York city. Health Affairs. Spring 1993;12(1):162–173.

    Article  CAS  PubMed  Google Scholar 

  4. Bindman A, Grumbach K, Osmond D, et al. Preventable hospitalizations and access to health care. Journal of the American Medical Association. July 26 1995;274(4):305–311.

    Article  CAS  PubMed  Google Scholar 

  5. Parchman ML, Culler SD. Preventable hospitalizations in primary care shortage areas. An analysis of vulnerable Medicare beneficiaries. Archives of Family Medicine. Nov-Dec 1999;8(6):487–491.

    Article  CAS  PubMed  Google Scholar 

  6. Josephson GW, Karcz A. The impact of physician economic incentives on admission rates of patients with ambulatory sensitive conditions: an analysis comparing two managed care structures and indemnity insurance. American Journal of Managed Care. Jan 1997;3(1):49–56.

    CAS  PubMed  Google Scholar 

  7. Gill JM, Mainous AG, 3rd The role of provider continuity in preventing hospitalizations. Archives of Family Medicine. Jul-Aug 1998;7(4):352–357.

    Article  CAS  PubMed  Google Scholar 

  8. Falik M, Needleman J, Herbert R, et al. Comparative effectiveness of health centers as regular source of care: application of sentinel ACSC events as performance measures. Journal of Ambulatory Care Management. Jan-Mar 2006;29(1):24–35.

    PubMed  Google Scholar 

  9. Bindman AB, Chattopadhyay A, Osmond DH, et al. The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions. Health Services Research. Feb 2005;40(1):19–38.

    Article  PubMed  Google Scholar 

  10. Blustein J, Hanson K, Shea S. Preventable hospitalizations and socioeconomic status. Health Affairs. Mar-Apr 1998;17(2):177–189.

    Article  CAS  PubMed  Google Scholar 

  11. Weissman JS, Gatsonis C, Epstein AM. Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. Journal of the American Medical Association. Nov 4 1992;268(17):2388–2394.

    Article  CAS  PubMed  Google Scholar 

  12. Himelhoch S, Weller WE, Wu AW, et al. Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Medical Care. Jun 2004;42(6):512–521.

    Article  PubMed  Google Scholar 

  13. Culler SD, Parchman ML, Przybylski M. Factors related to potentially preventable hospitalizations among the elderly. Medical Care. Jun 1998;36(6):804–817.

    Article  CAS  PubMed  Google Scholar 

  14. Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine. Nov 11 2002;162(20):2269–2276.

    Article  PubMed  Google Scholar 

  15. Roos LL, Walld R, Uhanova J, et al. Physician visits, hospitalizations, and socioeconomic status: ambulatory care sensitive conditions in a canadian setting. Health Services Research. Aug 2005;40(4):1167–1185.

    Article  PubMed  Google Scholar 

  16. Garg A, Probst JC, Sease T, et al. Potentially preventable care: ambulatory care-sensitive pediatric hospitalizations in South Carolina in 1998. Southern Medical Journal. Sep 2003;96(9):850–858.

    Article  PubMed  Google Scholar 

  17. Li Y, Glance LG, Cai X, et al. Mental illness and hospitalization for ambulatory care sensitive medical conditions. Medical Care. Dec 2008;46(12):1249–1256.

    Article  PubMed  Google Scholar 

  18. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. American Journal of Preventive Medicine. Feb 2008;34(2):143–152.

    Article  PubMed  Google Scholar 

  19. Solberg LI, Maciosek MV, Edwards NM, et al. Repeated tobacco-use screening and intervention in clinical practice: health impact and cost effectiveness. American Journal of Preventive Medicine. Jul 2006;31(1):62–71.

    Article  PubMed  Google Scholar 

  20. Hvidtfeldt UA, Rasmussen S, Gronbaek M, et al. Influence of smoking and alcohol consumption on admissions and duration of hospitalization. European Journal of Public Health. Sep 30 2009.

  21. Bryson CL, Au DH, Sun H, et al. Alcohol Screening Scores and Medication Nonadherence: A Cohort Study. Annals of Internal Medicine. 2008;149(11):795–803.

    PubMed  Google Scholar 

  22. Ahmed AT, Karter AJ, Liu J. Alcohol consumption is inversely associated with adherence to diabetes self-care behaviours. Diabetic Medicine. Jul 2006;23(7):795–802.

    Article  CAS  PubMed  Google Scholar 

  23. Rehm J, Gmel G, Sempos CT, et al. Alcohol-related morbidity and mortality. Alcohol Research & Health. 2003;27(1):39–51.

    Google Scholar 

  24. Fihn SD, McDonell MB, Diehr P, et al. Effects of sustained audit/feedback on self-reported health status of primary care patients. American Journal of Medicine. Feb 15 2004;116(4):241–248.

    Article  PubMed  Google Scholar 

  25. Bradley KA, Badrinath S, Bush K, et al. Medical risks for women who drink alcohol. Journal of General Internal Medicine. Sep 1998;13(9):627–639.

    Article  CAS  PubMed  Google Scholar 

  26. Risch HA, Howe GR, Jain M, et al. Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type. American Journal of Epidemiology. Sep 1 1993;138(5):281–293.

    CAS  PubMed  Google Scholar 

  27. Fan VS, Au DH, Heagerty PJ, et al. Validation of case-mix measures derived from self-reports of diagnoses and health. Journal of Clinical Epidemiology. 2002;55(4):371–380.

    Article  PubMed  Google Scholar 

  28. Bradley KA, DeBenedetti AF, Volk RJ, et al. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcoholism, Clinical and Experimental Research. Jul 2007;31(7):1208–1217.

    Article  PubMed  Google Scholar 

  29. Au DH, Kivlahan DR, Bryson CL, et al. Alcohol Screening Scores and Risk of Hospitalizations for Gi Conditions in Men. Alcoholism, Clinical and Experimental Research. Mar 2007;31(3):443–451.

    Article  PubMed  Google Scholar 

  30. Bradley KA, Maynard C, Kivlahan DR, et al. The relationship between alcohol screening questionnaires and mortality among male veteran outpatients. Journal of Studies on Alcohol. Nov 2001;62(6):826–833.

    CAS  PubMed  Google Scholar 

  31. Harris AH, Bryson CL, Sun H, et al. Alcohol Screening Scores Predict Risk of Subsequent Fractures. Substance Use and Misuse. Jun 17 2009;44:1055–1069.

    Article  PubMed  Google Scholar 

  32. Peytremann-Bridevaux I, Bradley KA, Bryson CL, et al. Alcohol screening results in elderly male veterans: association with health status and mortality. Journal of the American Geriatrics Society. Sep 2004;52(9):1510–1517.

    Article  Google Scholar 

  33. AHRQ. Prevention Quality Indicators Overview. AHRQ Quality Indicators. http://www.qualityindicators.ahrq.gov/pqi_overview.htm. Accessed September 2, 2005.

  34. Kinder LS, Bradley KA, Katon WJ, et al. Depression, posttraumatic stress disorder, and mortality. Psychosomatic Medicine. Jan 2008;70(1):20–26.

    Article  PubMed  Google Scholar 

  35. Berwick DM, Murphy JM, Goldman PA, et al. Performance of a five-item mental health screening test. Medical Care. Feb 1991;29(2):169–176.

    Article  CAS  PubMed  Google Scholar 

  36. Carter MW, Datti B, Winters JM. ED visits by older adults for ambulatory care-sensitive and supply-sensitive conditions. American Journal of Emergency Medicine. Jul 2006;24(4):428–434.

    Article  PubMed  Google Scholar 

  37. Fleming C, Fisher ES, Chang CH, et al. Studying outcomes and hospital utilization in the elderly. The advantages of a merged data base for Medicare and Veterans Affairs hospitals. Medical Care. May 1992;30(5):377–391.

    Article  CAS  PubMed  Google Scholar 

  38. Stata Statistical Software: Release Edition 9.1 [computer program]. Version. College Station, TX: Stata Corporation; 2005.

  39. Arcavi L, Benowitz NL. Cigarette smoking and infection. Archives of Internal Medicine. Nov 8 2004;164(20):2206–2216.

    Article  PubMed  Google Scholar 

  40. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. American Heart Association Task Force on Risk Reduction. Circulation. Nov 4 1997;96(9):3243–3247.

    CAS  PubMed  Google Scholar 

  41. Haire-Joshu D, Glasgow RE, Tibbs TL. Smoking and diabetes. Diabetes Care. Nov 1999;22(11):1887–1898.

    Article  CAS  PubMed  Google Scholar 

  42. Chuahirun T, Wesson DE. Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition. American Journal of Kidney Diseases. Feb 2002;39(2):376–382.

    Article  PubMed  Google Scholar 

  43. Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. Journal of General Internal Medicine. Apr 2009;24(4):457–463.

    Article  PubMed  Google Scholar 

  44. Revicki D, Sobal J, DeForge B. Smoking status and the practice of other unhealthy behaviors. Family Medicine. Jul 1991;23(5):361–364.

    CAS  PubMed  Google Scholar 

  45. Strine TW, Okoro CA, Chapman DP, et al. Health-related quality of life and health risk behaviors among smokers. American Journal of Preventive Medicine. Feb 2005;28(2):182–187.

    Article  PubMed  Google Scholar 

  46. Alexandre PK, Roebuck MC, French MT, et al. Problem drinking, health services utilization, and the cost of medical care. Recent Developments in Alcoholism. 2001;15:285–298.

    Article  CAS  PubMed  Google Scholar 

  47. Hunkeler EM, Hung YY, Rice DP, et al. Alcohol consumption patterns and health care costs in an HMO. Drug and Alcohol Dependence. Oct 1 2001;64(2):181–190.

    Article  CAS  PubMed  Google Scholar 

  48. Howard AA, Arnsten JH, Gourevitch MN. Effect of alcohol consumption on diabetes mellitus: a systematic review. Annals of Internal Medicine. Feb 3 2004;140(3):211–219.

    PubMed  Google Scholar 

  49. Green CA, Polen MR. The health and health behaviors of people who do not drink alcohol. American Journal of Preventive Medicine. Nov 2001;21(4):298–305.

    Article  CAS  PubMed  Google Scholar 

  50. Zilkens RR, Puddey IB. Alcohol and cardiovascular disease—more than one paradox to consider. Alcohol and type 2 diabetes—another paradox? Journal of Cardiovascular Risk. Feb 2003;10(1):25–30.

    Article  PubMed  Google Scholar 

  51. Klatsky AL. Alcohol and cardiovascular disease—more than one paradox to consider. Alcohol and hypertension: does it matter? Yes. Journal of Cardiovascular Risk. Feb 2003;10(1):21–24.

    Article  PubMed  Google Scholar 

  52. Helmer DA, Tseng CL, Brimacombe M, et al. Applying diabetes-related Prevention Quality Indicators to a national cohort of veterans with diabetes. Diabetes Care. Nov 2003;26(11):3017–3023.

    Article  PubMed  Google Scholar 

  53. Tisnado DM, Adams JL, Liu H, et al. What is the Concordance Between the Medical Record and Patient Self-Report as Data Sources for Ambulatory Care? Medical Care. 2006;44(2):132–140.

    Article  PubMed  Google Scholar 

  54. Bradley KA, Williams EC, Achtmeyer CE, et al. Implementation of evidence-based alcohol screening in the Veterans Health Administration. American Journal of Managed Care. Oct 2006;12(10):597–606.

    PubMed  Google Scholar 

  55. Shaper AG. Mortality and alcohol consumption. Non-drinkers shouldn't be used as baseline. British Medical Journal. Feb 4 1995;310(6975):325.

    CAS  PubMed  Google Scholar 

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Acknowledgments

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (HSR&D) Grant IIR (#IAC 05-206-1); Dr. Chew was a Fellow with the VA Puget Sound HSR&D at the time this research was begun. Dr. Bryson was supported by a VA Career Development Award (RCD03-177). Views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Washington. The authors acknowledge Emily C. Williams, PhD, MPH and Madeleine S. Frey for help in manuscript preparation.

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Correspondence to Katharine A. Bradley MD, MPH.

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Chew, R.B., Bryson, C.L., Au, D.H. et al. Are Smoking and Alcohol Misuse Associated with Subsequent Hospitalizations for Ambulatory Care Sensitive Conditions?. J Behav Health Serv Res 38, 3–15 (2011). https://doi.org/10.1007/s11414-010-9215-x

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