Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

Lynch, Brenda; Fitzgerald, Anthony P.; Corcoran, Paul; Buckley, Claire; Healy, Orla; Browne, John

doi:10.1136/bmjqs-2018-008002

Cited by 31 publications

(31 citation statements)

References 42 publications

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“…Despite their use to monitor healthcare systems, the effectiveness of ACSCs as an indicator has been debated 15 16. Recent work from Lynch et al 6 concluded that ‘the distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates’, when looking at county-level variation in emergency admissions in Ireland from 2014 to 2016. The researchers found that similar factors (unemployment, hospital admission policy and private health insurance coverage) were associated with both care-sensitive and total emergency admissions.…”

Section: The Multifactorial Nature Of All Hospital Admissionsmentioning

confidence: 99%

“…They are designed to capture how ambulatory care might impact on rates of emergency admissions. However, in this issue of BMJ Quality and Safety , Lynch et al 6 question the merits of distinguishing ACSCs from other emergency admissions. Examining factors associated with county-level variation in emergency admissions in Ireland, they found similar factors were associated with both all emergency admissions and ACSCs.…”

mentioning

confidence: 99%

“…Examining factors associated with county-level variation in emergency admissions in Ireland, they found similar factors were associated with both all emergency admissions and ACSCs. Lynch and colleagues concluded that ‘the distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed’ 6…”

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confidence: 99%

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Ambulatory care-sensitive conditions: their potential uses and limitations

2019

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Section: The Multifactorial Nature Of All Hospital Admissionsmentioning

confidence: 99%

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confidence: 99%

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Ambulatory care-sensitive conditions: their potential uses and limitations

2019

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“…In the literature, ACSC analyses to date recognises the impact on emergency departments and admissions. Drivers of these admissions have been examined highlighting the association with levels of primary care provision, as well as higher levels of deprivation 1 8–10. However, the use of ACSC analysis to identify and prioritise areas for improved primary care resources and programmes of care remains unexamined.…”

Section: Introductionmentioning

confidence: 99%

Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

McDarby

Smyth

2019

BMJ Open

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BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.

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“…Rates of ACSC hospitalisations are also influenced by demographic, socioeconomic and health system factors [21,22]. These factors will in turn influence the case mix of patients, which undoubtedly has an effect on mortality following these admissions.…”

Section: Discussionmentioning

confidence: 99%

Mortality related to ambulatory care sensitive hospitalisations in Finland

Partanen

Arffman

Manderbacka

et al. 2020

Scand J Public Health

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Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends in the mortality indicating variations in ambulatory care sensitive conditions outcomes. Methods: This retrospective cohort study used individual-level data from national registers concerning ambulatory care sensitive condition hospitalisations. Crude and age-adjusted 365-day mortality rates for the first ambulatory care sensitive condition-related admission were calculated for vaccine-preventable, acute, and chronic ambulatory care sensitive conditions separately, and for three time periods stratified by gender. The mortality rates were also compared to mortality in the general Finnish population to assess the excess mortality related to ambulatory care sensitive condition hospitalisations. Results: The data comprised a total of 712,904 ambulatory care sensitive condition hospital admissions with the crude 365-day mortality rate of 14.2 per 100 person-years. Mortality for those hospitalised for vaccine-preventable conditions was approximately 10-fold compared to the general population and four-fold in chronic and acute conditions. Of the 10 most common ambulatory care sensitive conditions, bacterial pneumonia and influenza and congestive heart failure were associated with highest age-standardised mortality rates. Conclusions: Hospitalisations for ambulatory care sensitive conditions were shown to be associated with excess mortality in patients compared to the general population. Major differences in mortality were found between different types of ambulatory care sensitive condition admissions. There were also minor differences in mortality between hospital districts. These differences are important to consider when using preventable hospital admissions as an indicator of primary care performance.

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Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

Cited by 31 publications

References 42 publications

Ambulatory care-sensitive conditions: their potential uses and limitations

Ambulatory care-sensitive conditions: their potential uses and limitations

Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

Mortality related to ambulatory care sensitive hospitalisations in Finland

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