Risk-adjusted, state-level measure that assesses the rates of hospital admissions for ambulatory care sensitive conditions per 1,000 Medicaid HCBS participants aged 18 years and older.

The number of HCBS participants who had an inpatient admission for either an accurate or a chronic condition during the measurement period; this rate sums the values from the chronic conditions rate and the acute conditions rate.

Adults receiving Medicaid HCBS, aged 18 years and older, within each state during the measurement period.

Denominator exclusions: acute hospital transfers, hospice and hospitalisations for obstetric conditions. Chronic Conditions exclusions: A procedure code for lower extremity amputation AND any diagnosis for diabetes - Excluding any discharge with a diagnosis for traumatic amputation of the lower extremity or toe amputation procedure. Primary diagnosis of chronic obstructive pulmonary disease or persistent asthma - Excluding any discharge with a diagnosis for cystic fibrosis and anomalies of the respiratory system. Primary diagnosis of heart failure - Excluding any discharges with a cardiac procedure. Primary diagnosis of hypertension - Excluding any discharge with a cardiac procedure or diagnosis of State I–IV kidney disease with a dialysis procedure. Acute Conditions exclusions: Primary diagnosis of pneumonia - Excluding any discharge with a diagnosis of sickle cell anaemia, haemoglobin S disease or procedure or diagnosis for immunocompromised state. Primary diagnosis of complicated urinary tract infection - Excluding any discharge with a diagnosis of kidney or urinary tract disorder or procedure or diagnosis for immunocompromised state. Primary diagnosis of cellulitis or pressure ulcer - Excluding any discharge with a procedure or diagnosis for immunocompromised state.

Age, biological sex, race or ethnicity, age, dually enrolled status, rurality, history of prior hospitalisation, Hierarchical Condition Categories [HCC] in the measurement period, and submitting state

Claims data

p4qm.org/measures

p4qm.org/measures/4490