Acute Hospital Utilization (AHU)

Assesses the rate of acute inpatient and observation stay discharges among commercial (18 and older), Medicaid (18 to 64) and Medicare (18 to 64, 65 and older) health plan members. As well as reporting observed rates, NCQA also specifies that plans report an expected count of unplanned acute discharges, predicted using members’ prior and current health, among other factors. The observed event count and the expected event count are used to calculate a calibrated observed-to-expected (O/E) ratio that assesses whether plans had more, the same or fewer unplanned acute discharges than predicted by their case mix, while accounting for incremental improvements across all plans over time. An O/E ratio below 1 indicates better-than-average performance and an O/E ratio above 1 indicates worse-than-average performance.

Why It Matters

In 2019, 5.9% of people had had a hospital stay in the past year.¹ Hospital care accounts for 31% of health spending in the U.S.² A study found that inpatient admission costs account for 21% of total Medicare benefit payments.³ Hospital stays have been associated with preventable and serious adverse events for patients. A 2023 study of Massachusetts hospitals found nearly 7% of inpatient hospitalizations have a preventable adverse event and 1% of inpatient hospitalizations have a preventable adverse event that is serious, life-threatening or fatal.⁴ Studies show that nearly one-third of adults hospitalized in the intensive care unit develop a hospital-acquired infection.⁵ Older patients in particular are at increased risk for delirium, falls, and lower overall functioning while hospitalized.^6,7 Some hospitalizations can be avoided with improved access to care, timely delivery of care and appropriate care coordination.

Historical Results – National Averages

Performance results for this measure are currently unavailable. Visit our Quality Compass page to explore data licensing options and gain access to detailed performance results for this measure.