Healthy Development Measurement Toolkit

Health Outcome HO.4 Heart failure hospitalization rate per 10,000

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Data Source

Hospitalization data by individual zip code for 2007-2009 were provided by the administrators of 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://www.oshpd.ca.gov/hid/products/preventable_hospitalizations/pdfs/PH_REPORT_WEB.pdf

Explanation and Limitations

This indicator shows San Francisco's hospitalization rate due to adult non-hypertensive congestive heart failure. Data are age-adjusted per 10,000 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, "Congestive heart failure (CHF) is a condition in which the heart can't pump enough blood to the body's other organs. This can result from a variety of conditions including coronary artery disease, diabetes, past heart attack, hypertension, heart infections, diseases of the heart valves or muscle, and congenital heart defects. Because the heart is not able to work efficiently, blood backs up in the tissues causing edema or swelling. Edema can occur in the legs and ankles as well as in the lungs, where it causes shortness of breath, especially while lying down.

Around 5 million people in the United States have heart failure, and more than 287,000 people in the United States die each year with the disease. The estimated direct cost for heart failure in the U.S. in 2006 was $29.6 billion. According to the National Hospital Discharge Survey, hospitalizations for heart failure have increased from 402,000 in 1979 to 1,101,000 in 2004."

CHF is considered an "Ambulatory Care Sensitive Condition" (ACSC). "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.)'"

The data shown here do not identify what barriers are responsible for the different hospitalization rates, nor do they identify whether the barriers are in the health care system or in the preferences and practices of individuals or communities.

Geographic differences in ACSC hospitalizations 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 hospitalization rates for ACS conditions indicate poor access to outpatient health care.