What health quality indicators in Mississippi reveal about chronic disease and the health care system

Background: Mississippi ranks poorly in preventable hospitalization and premature death rates, low in managed care penetration and public health investment, and high in chronic disease rates. The current health system creates a burden on resources and excess disability from chronic disease complications. Current health system changes are ongoing so providers must adapt to new structures. An opportunity exists to ensure changes work in concert to shift the health system toward high quality preventive and primary care rather than continuing to manage delayed care consequences. Objective: Evaluate acute care quality measures for chronic conditions and implications for improving the health care system. Methods: Mixed-methods analysis of acute care hospitalizations (n = 40,753) during 2010 for chronic conditions comprising the Agency for Healthcare Quality and Research's Prevention Quality Indicators (PQIs); federal/state policy and literature review; and stakeholder survey. Results: Hospital admission rates for select chronic disease PQIs are significantly (p<.05) higher in Mississippi as compared to national rates: hypertension (34%); congestive heart failure (6%); diabetes short-term complications (27%); diabetes long-term complications (10%); uncontrolled diabetes (35%); lower-extremity amputations for diabetes (17%); chronic obstructive pulmonary disease or asthma in older adults (11%); and asthma in younger adults (9%). Overall chronic disease PQI rate in Mississippi is significantly (p<.01) higher (11%). Conclusions: Comprehensive, interrelated policies to address health care workforce development and education, payment reform, data collection, and quality measurement are in progress. Further coordinated efforts to enhance access to preventive/primary care and payment reforms to alter financial incentives are necessary for improving care quality and chronic disease outcomes.