Healthy Development Measurement Toolkit

Health Outcome HO.3 Chronic obstructive pulmonary disease hospitalization rate per 1,000

Data Source

Hospitalization and ER data for 2005 – 2007 were accessed via the Health Matters in San Francisco website: http://www.healthmattersinsf.org/index.php. Health Matters in SF compiled the data from California Office of Statewide Health Planning and Development (OSHPD). For more information on these preventable hospitalizations, visit: http://oshpd.cahwnet.gov/HID/Products/PatDischargeData/ResearchReports/PrevntbleHosp/PQIReport.pdf

Explanation and Limitations

This indicator shows San Francisco's hospitalization rate due to chronic obstructive pulmonary disease. Data are age-adjusted per 1,000 population. Rates were calculated using population figures from the 2000 U.S. Census. Age standardization allows comparisons across counties or by zip codes that differ in size or age composition.

From the Health Matters in SF website, "Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing-related problems. According to the American Lung Association, COPD includes chronic bronchitis, emphysema, and bronchiectasis. It does not include other obstructive diseases such as asthma. COPD is the fourth leading cause of death in America, claiming the lives of 122,283 Americans in 2003. COPD is often related to tobacco use, but can also be caused by air pollutants in the home and workplace, genetic factors, and respiratory infections. In 2004, the cost to the nation for COPD was approximately $37.2 billion, including healthcare expenditures of $20.9 billion in direct health care expenditures, $7.4 billion in indirect morbidity costs and $8.9 billion in indirect mortality costs."

COPD is considered an "Ambulatory Care Sensitive Condition" (ACSC). "The analysis of hospitalizations for by geographic area is an indicator of access to ambulatory care services. ACSCs are 'diagnoses for which timely and effective outpatient care can help to reduce the risks of hospitalization by either preventing the onset of an illness or condition, controlling an acute episodic illness or condition, or managing a chronic disease or condition. (J. Billings, et al., "Impact of Socioeconomic Status on Hospital Use in New York City," Health Affairs, 1993, 12(1): 162-173.)'"

This measure does not identify what barriers are responsible for the differences, nor does it identify whether the barriers are in the health care system or in the preferences and practices of individuals or communities.

Ambulatory care sensitive conditions are just one indicator of inadequate access to health care in San Francisco. Other factors such as health insurance coverage, transportation to and from the health facility, cultural competency or cultural humility of health care providers, hours of operation, length of reimbursement period, cultural and linguistic competency of administrative and intake staff, availability of child care, availability of prevention programs, and employer requirements are among many factors impeding reliable, continuous access to affordable, quality health care.

Why is this a Community Health Indicator?

Ambulatory care sensitive (ACS) conditions such as asthma, diabetes, chronic obstructive pulmonary disease and congestive heart failure are conditions for which hospitalization can usually be prevented when they have been effectively managed in outpatient settings. High rates of ACS conditions indicate poor access to outpatient health care.