From 1991 to 1994, these grants provided support to the United Hospital Fund of New York to develop, validate and implement a research technique called small-area analysis, used to identify communities with high rates of unnecessary hospitalization and limited access to primary care.

During the first phase of the project investigators studied differences in hospitalization rates for "ambulatory-care-sensitive" (ACS) conditions, such as bacterial pneumonia and otitis media (a severe ear infection), which can be reduced with timely and effective outpatient care.

During the second phase, investigators further analyzed data on preventable hospitalization in New York City and applied the small-area analysis technique to urban areas throughout the country.

Key Findings: The findings validated the use of small-area analysis as a technique to identify and measure differences in hospitalization rates for ACS conditions.

• Hospitalization for these ACS conditions was two to 10 times greater in low-income than in high-income neighborhoods in New York City.
• Poor African-American areas in New York City had consistently higher hospitalization rates than other low-income areas.
• More than half of all low-income patients in New York City reported access problems that delayed or prevented them from obtaining care.
• More than half the low-income areas in urban communities of Massachusetts, New York, New Jersey, Florida, Oregon, California and Washington state had substantially higher admission rates for ACS conditions than did high-income areas.