How do population, general practice and hospital factors influence ambulatory care sensitive admissions: a cross sectional study

Abstract

BackgroundReducing unplanned hospital admissions is a key priority within the UK and other healthcare systems, however it remains uncertain how this can be achieved. This paper explores the relationship between unplanned ambulatory care sensitive condition (ACSC) admission rates and population, general practice and hospital characteristics. Additionally, we investigated if these factors had a differential impact across 28 conditions.MethodsWe used the English Hospital Episode Statistics to calculate the number of unplanned ACSC hospital admissions for 28 conditions at 8,029 general practices during 2011/12. We used multilevel negative binomial regression to estimate the influence of population (deprivation), general practice (size, access, continuity, quality, A&E proximity) and hospital (bed availability, % day cases) characteristics on unplanned admission rates after adjusting for age, sex and chronic disease prevalence.ResultsPractices in deprived areas (at the 90th centile) had 16% (95% confidence interval: 14 to 18) higher admission rates than those in affluent areas (10th centile). Practices with poorer care continuity (9%; 8 to 11), located closest to A&E (8%; 6 to 9), situated in areas with high inpatient bed availability (14%; 10 to 18) or in areas with a larger proportion of day case admissions (17%; 12 to 21) had more admissions. There were smaller associations for primary care access, clinical quality, and practice size. The strength of associations varied by ACSC. For example, deprivation was most strongly associated with alcohol related diseases and COPD admission rates, while continuity of primary care was most strongly associated with admission rates for chronic diseases such as hypertension and iron-deficiency anaemia.ConclusionsThe drivers of unplanned ACSC admission rates are complex and include population, practice and hospital factors. The importance of these varies markedly across conditions suggesting that multifaceted interventions are required to avoid hospital admissions and reduce costs. Several of the most important drivers of admissions are largely beyond the control of GPs. However, strategies to improve primary care continuity and avoid unnecessary short-stay admissions could lead to improved efficiency.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-017-0638-9) contains supplementary material, which is available to authorized users.

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

“…This study distinctively focuses on chronic ACSC hospitalizations. Prior studies using international definitions often combine both acute and chronic ACSC conditions, which may mask differential risk factors [5,10,71]. Canadian studies of chronic ACSC hospitalizations have identified rurality, immigrant status, lower income, smoking, underweight, and comorbidities as independent risk factors [16,19].…”

“…In the Canadian health system, hospitalizations for seven chronic ACSCs are routinely monitored, namely angina, asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes and diabetic complications, epilepsy, and hypertension [3]. Hospitalizations for chronic ACSCs may more specifically indicate insufficient disease management [4][5][6][7][8][9]. Studies have characterized risk factors for ACSC hospitalizations including demographics [10][11][12][13][14][15][16][17][18][19], rurality [5,17,[20][21][22][23][24][25][26], socioeconomic status (SES) [1,5,[15][16][17][26][27][28][29][30][31][32][33][34][35][36][37][38], chronic morbidities [10,16,17,…”

Ambulant-sensitive Krankenhausfälle in Deutschland – Abgrenzung, Prävalenz und Kosten

“…B. in Bezug auf systemimmanente und systemexterne Faktoren [8]. Initiale Analysen für Deutschland [1,10] berufen sich dabei auf die für das britische NHS-System entwickelte ASK-Klassifikation [6,11].…”

“…Bezüglich der Ursachen von ASK werden systemimmanente Faktoren zugangsseitig sowohl mit einer ungenügenden ambulanten Infrastruktur (z. B. Ärztedichte [12]), einem geringen Leistungsangebot [1] sowie im weiteren Sinne mit der Organisation des Krankenhaussektors begründet [1,11]. Qualitätseinbußen des ambulanten Bereichs können beispielsweise auf eine mangelnde Koordination zwischen den behandelnden Ärzten oder auf ein finanzielles Anreizsystem mit Auswirkungen auf die Behandlung zurückzuführen sein [8].…”

“…ASK entstehen nicht ausschließlich als Folge derartiger Faktoren. Weitere Variablen umfassen externe bevölkerungsrelevante Ursachen, wie die sozioökonomische Lage, Demographie, Morbidität und persönliche Situation der Patienten [1,11,14,15]. Basiert ein ASK primär auf derartigen Faktoren außerhalb des Gesundheitssystems, kann gemäß Gibbons et al (2012) allerdings nicht regelhaft davon ausgegangen werden, dass eine Hospitalisierung durch effektive und zeitnahe Intervention im ambulanten Sektor vermeidbar gewesen wäre [16].…”