D.C. Troubled by Rise in Avoidable Hospitalizations

The District is seeing more avoidable hospitalizations among children and middle-aged adults, a puzzling trend that includes insured and uninsured groups and raises complex issues of health-care access, quality and capacity.

Statistics released yesterday by Rand, an independent research organization, show that the rate of these hospitalizations -- which could have been averted through good primary care -- climbed from 39.1 per 1,000 adults ages 40-64 in 2004 to 43.4 in 2006. Among children through age 17, the rate jumped from 8.9 to 12.1.

Health officials said they cannot fully explain what is causing the increase. They began to see a rise in 2005 and tied most of it to skin infections involving MRSA, the antibiotic-resistant staph bacteria that has attracted attention recently because of diagnoses in school districts across the region.

The 2006 numbers suggest that far more is to blame, including a primary care system that is overloaded, packed emergency rooms and potentially sicker patients. Higher rates of asthma among children in certain areas of the city appear to be a potential factor, too.

Whatever the reasons, officials described the trend as troublesome.

"It's a problem for all of us," said Nicole Lurie, a physician and senior scientist at Rand. "These things are not headed in the right direction."

The Rand analysis of health-care patterns in the District was presented at the annual meeting of the D.C. Primary Care Association. At the association's request, Rand has looked for several years at health-care needs, especially as they relate to chronic disease, low-income residents and hospital use.

The data released yesterday will soon become part of a $1.5 million study commissioned by the D.C. Council. By late December, officials said, they will have the fullest picture ever of the utilization of city emergency services, hospital overcrowding and, as Lurie put it, "who's getting what care where."

That information is supposed to guide the council in deciding how $116 million in tobacco settlement funds should be spent. Council members originally intended the money for a sophisticated health complex on the grounds of the former D.C. General Hospital in Southeast and several state-of-the-art community clinics that would bolster services in Wards 7 and 8.

An additional $80 million was to go toward urgent or emergency care improvements, most likely at Greater Southeast Community Hospital and Howard University Hospital. The Rand study was to direct that allocation, too. But this week, the financial crisis that pushed Greater Southeast to the verge of closure prompted the council to agree to spend virtually all of the remaining tobacco money to help sell the facility and support an extensive rehabilitation.

The latest data show that although many people who live east of the Anacostia River go to Washington Hospital Center when ill or hurt, Greater Southeast retains a sizable base of patients among adults in Wards 6 and 8. "Even in these worst of times," noted Sharon Baskerville, executive director of the primary care association, who admitted surprise at the patient share for Greater Southeast.

Yesterday's report is Rand's most comprehensive on the subject because all District hospitals participated.

"The good news is that we've had a real breakthrough" in cooperation, Baskerville said. The bad news? The results "stirred up questions that [the D.C. Health Department] should be looking at and doesn't have the capability."

The interim health director, Carlos Cano, agreed that the department must understand how the city's health is changing, starting with the rise in avoidable hospitalizations. "It's very difficult to pin down why it's happening," he said.