Is secondary preventive care improving? Observational study of 10-year trends in emergency admissions for conditions amenable to ambulatory care

Abstract

ObjectiveTo identify trends in emergency admissions for patients with clinical conditions classed as ‘ambulatory care sensitive’ (ACS) and assess if reductions might be due to improvements in preventive care.DesignObservational study of routinely collected hospital admission data from March 2001 to April 2011. Admission rates were calculated at the population level using national population estimates for area of residence.ParticipantsAll emergency admissions to National Health Service (NHS) hospitals in England from April 2001 to March 2011 for people residents in England.Main outcome measuresAge-standardised emergency admissions rates for each of 27 specific ACS conditions (ICD-10 codes recorded as primary or secondary diagnoses).ResultsBetween April 2001 and March 2011 the number of admissions for ACS conditions increased by 40%. When ACS conditions were defined solely on primary diagnosis, the increase was less at 35% and similar to the increase in emergency admissions for non-ACS conditions. Age-standardised rates of emergency admission for ACS conditions had increased by 25%, and there were notable variations by age group and by individual condition. Overall, the greatest increases were for urinary tract infection, pyelonephritis, pneumonia, gastroenteritis and chronic obstructive pulmonary disease. There were significant reductions in emergency admission rates for angina, perforated ulcers and pelvic inflammatory diseases but the scale of these successes was relatively small.ConclusionsIncreases in rates of emergency admissions suggest that efforts to improve the preventive management of certain clinical conditions have failed to reduce the demand for emergency care. Tackling the demand for hospital care needs more radical approaches than those adopted hitherto if reductions in emergency admission rates for ACS conditions overall are to be seen as a positive outcome of for NHS.

An evaluation of the effectiveness of annual health checks and quality of health care for adults with intellectual disability: an observational study using a primary care database

“…151 Although our primary outcome of DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk overall emergency hospital admission showed no change after the introduction of health checks for adults with ID, the evidence for a reduction in potentially preventable admissions was more consistent, and plausible. Given that admissions for ACSCs represent less than one in five emergency admissions in the UK, 41 it is perhaps not surprising that we failed to detect a change among the broader group of all emergency admissions.…”

“…Although multiple episodes can sometimes occur within a continuous period of hospitalisation (such as when a patient is transferred to a different consultant), we decided to focus solely on the initial episode as we were interested in the reason for admission that this represented. 41 We categorised admissions, using the method of admission variable ADMIMETH, 79 into the following groups: emergency, elective, maternity and other (such as transfers from other hospital providers). Within emergency admissions, we further identified a subgroup of admissions for ACSCs, 41 which represent a group thought to be potentially preventable with better clinical management.…”

“…41 We categorised admissions, using the method of admission variable ADMIMETH, 79 into the following groups: emergency, elective, maternity and other (such as transfers from other hospital providers). Within emergency admissions, we further identified a subgroup of admissions for ACSCs, 41 which represent a group thought to be potentially preventable with better clinical management. We included 20 widely used ACSCs, but also considered an additional five conditions relevant to the population with ID.…”

“…Thus, we will also investigate a subgroup of emergency admissions for ambulatory care-sensitive conditions (ACSCs). 41 These admissions are thought to be potentially preventable with better clinical management in primary care. There is some variation in how ACSCs are explicitly defined, 42 particularly as they were originally developed in the USA.…”

“…We also take advantage of the linkage by comparing the primary care record prior to admission for two infections, UTIs and LRTIs, which we suspected would be common in both adults with ID and the general population. 41 Analyses are, again, based on 343 practices with linked data (see Figure 2). We used the same longitudinal design that was introduced for mortality analyses in Chapter 4, involving a total of 16,666 adults with ID and 113,562 age-, gender-and practice-matched controls without ID (see Figure 26).…”