Hospitalisation for Potentially Preventable Complications

Identifying Attributes

Care Settings
Hospital Care
Country
United States of America
Publishing Organisation
National Committee for Quality Assurance (NCQA): Healthcare Effectiveness Data and Information Set (HEDIS)
Type of Quality Indicator
Outcome
IOM Quality Dimension
Effectiveness
Domain
Complications and Adverse Events

Defining Attributes

Definition

Hospital inpatient admissions and observation stays due to complications of ambulatory care-sensitive conditions (ACSC) among Medicare members 67 years of age and older.

Numerator
Denominator
Exclusions
Use of Risk Adjustment
Yes
Risk Adjustments

Rates are used to calculate a calibrated observed-to-expected ratio of hospitalisations for potentially preventable complications of ACSC that assesses whether plans had more, the same or less hospitalisations than expected, while accounting for incremental improvements across all plans over time. The observed-to-expected ratio is multiplied by the hospitalisation rate across all health plans to produce a risk-standardised rate which allows for national comparison

Stratifications

By ambulatory care sensitive condition (chronic, acute) and organisation (Medicare HMO, Medicare PPO).

Collection and Reporting Attributes

Type of Data Collection
Administrative data, Surveys
Data Collection Methods

Healthcare Effectiveness Data and Information Set (HEDIS)

Frequency of Data Collection
Data are submitted at will by approved organisations to NCQA for aggregation and annual reporting.
Frequency of Data Collection in Days
1
Reporting Methods

HEDIS measures are reported on by the NCQA in a variety of specialised annual reports, but may also be utilised and reported on by other organisations with permission from NCQA.

Reporting Frequency
Annually
Reporting Frequency in Days
365
Indicator Has Recommended Targets
No

Source and Reference Attributes

Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
02 December 2025