A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological study

Abstract

BackgroundSome emergency admissions can be avoided if acute exacerbations of health problems are managed by the range of health services providing emergency and urgent care.AimTo identify system-wide factors explaining variation in age sex adjusted admission rates for conditions rich in avoidable admissions.DesignNational ecological study.Setting152 emergency and urgent care systems in England.MethodsHospital Episode Statistics data on emergency admissions were used to calculate an age sex adjusted admission rate for conditions rich in avoidable admissions for each emergency and urgent care system in England for 2008–2011.ResultsThere were 3 273 395 relevant admissions in 2008–2011, accounting for 22% of all emergency admissions. The mean age sex adjusted admission rate was 2258 per year per 100 000 population, with a 3.4-fold variation between systems (1268 and 4359). Factors beyond the control of health services explained the majority of variation: unemployment rates explained 72%, with urban/rural status explaining further variation (R2=75%). Factors related to emergency departments, hospitals, emergency ambulance services and general practice explained further variation (R2=85%): the attendance rate at emergency departments, percentage of emergency department attendances converted to admissions, percentage of emergency admissions staying less than a day, percentage of emergency ambulance calls not transported to hospital and perceived access to general practice within 48 h.ConclusionsInterventions to reduce avoidable admissions should be targeted at deprived communities. Better use of emergency departments, ambulance services and primary care could further reduce avoidable emergency admissions.

Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?

“…It may be that factors associated with non-urgent presentations are outside the control of hospitals themselves. A study investigating variations in potentially avoidable ED presentations found that socioeconomic factors, particularly employment status, accounted for over 70% of the variation, with a further 15% explained by hospital factors and access to GPs 25. In contrast, this study only demonstrated a weak association with surrogate markers of socioeconomic status, as well as time and day of presentation, suggesting that access to GPs may play only a minor role in these low acuity ED presentations.…”

Factors influencing unspecified chest pain admission rates in England

“…This suggests that the deprivation of a community increases the rate of potentially avoidable admissions with unspecified chest pain. This corresponds to findings in a wider study of potentially avoidable admissions which found that deprivation accounted for 72% of the variation in their admission rates 5. The effect is not as powerful in our study suggesting that other factors impact on chest pain admission rates.…”

“…Our findings reflect those of previous studies that have shown that deprivation and provision of beds are both associated with admission rates 5 6. Other studies have evaluated the role of technologies and services in reducing chest pain admissions and have produced mixed results.…”

“…The Emergency Admissions Study aimed to identify modifiable system factors that explain avoidable emergency admissions 5. The study identified 14 admission codes (including unspecified chest pain) that were judged by expert opinion to be rich in avoidable admissions and accounted for 22% of emergency admissions to English hospitals in 2008–2011.…”

Variation in Emergency Department Admission Rates in US Children’s Hospitals

“…[2][3][4][5][6] Some of the variation in care may be related to patientlevel differences in clinical presentation as well as to hospital-level factors, such as local availability of primary care physicians, hospital occupancy, or access to certain health care services. [7][8][9] The wide variation in clinical management raises concerns about whether every patient is receiving the optimal care and whether the lack of a standardized approach is contributing to unnecessary health care costs. [10][11][12] Additional testing and treatment have not necessarily been found to correlate with more effective care, improved patient outcomes, or higher patient satisfaction.…”