Presentation (CTI)

OBJECTIVES: To examine changes in the rate and pattern of preventable hospitalizations (PH) in Kentucky before and after Medicaid expansion in 2014.
METHODS: A retrospective cohort study used Kentucky’s all-payers claims database (KY Health Services and Facility Data) from 2009-2024. Hospitalizations for PHwere identified for selected AHRQ Prevention Quality Indicators using ICD-9-CM/ICD-10-CM diagnosis codes, specifically diabetes short-term complications, diabetes long-term complications, uncontrolled diabetes, diabetes amputation, hypertension, heart failure (HF), and urinary tract infection (UTI).
RESULTS: Overall, the number of inpatient hospitalizations declined significantly, from 654,659 in 2009 to 568,259 in 2024, while the proportion of PH among all hospitalizations remained stable at approximately 5.7%. Medicaid hospitalizations, however, increased from 140,893 in 2009 to 155,799 in 2024, primarily after the Medicaid expansion in 2014. Also, the proportion of PH in all Medicaid hospitalizations jumped from approximately 3.0% pre-expansion to approximately 4.0% post-expansion (i.e., from 4,380 out of 140,893 to 6,084 out of 155,799). Condition-specific trends revealed substantial heterogeneity. HF consistently accounted for the largest share of Medicaid PH and increased over time, rising from 26.6% to 33.4%. In contrast, UTIs’ share in Medicaid PH declined from 31.9% to 9.7%. Diabetes-related Medicaid PH increased overall: short-term complications rose from 17.9% to 25.7%, long-term complications from 11.6% to 16.2%, and diabetes amputation from 1.7% to 3.0%. Uncontrolled diabetes fluctuated (4.2%-7.0%) without a clear trend. Hypertension’s share increased from 5.6% to 7.7%.
CONCLUSIONS: Despite declining inpatient hospitalization, PH remained stable overall but increased among Medicaid hospitalizations, driven largely by HF, suggesting possible gaps in outpatient chronic disease management.