Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation

Busby, John; Purdy, Sarah; Hollingworth, William

doi:10.3399/bjgp16x687949

Cited by 20 publications

(18 citation statements)

References 15 publications

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“…ACSCs are conditions where improved primary and community care could potentially prevent the need for hospital admission [ 6 ]. Substantial unexplained geographic variation in ACSC admission rates [ 7 , 8 ] suggests reductions might be possible, however it remains uncertain how these can be achieved. Knowledge of how population (e.g.…”

Section: Introductionmentioning

confidence: 99%

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

2017

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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.

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Section: Introductionmentioning

confidence: 99%

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

2017

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“…As concluded from earlier research, ACSC are conditions that may be treated effectively in outpatient care settings and thus with great potential for reducing the need for inpatient care. 15,16 We found out patients hospitalized with primary diagnoses of ACSC were less likely to be discharged to their homes. Although this study could not clarify the reason for this trend, one possible explanation is that persons admitted with ACSC might be admitted when in very severe state with these conditions due to delays in seeking care or other reasons related to their use of primary care services.…”

Section: Discussionmentioning

confidence: 89%

An Examination of the Likelihood of Home Discharge After General Hospitalizations Among Medicaid Recipients

Mkanta

Chumbler

Yang

et al. 2017

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Ability to predict discharge destination would be a useful way of optimizing posthospital care. We conducted a cross-sectional, multiple state study of inpatient services to assess the likelihood of home discharges in 2009 among Medicaid enrollees who were discharged following general hospitalizations. Analyses were conducted using hospitalization data from the states of California, Georgia, Michigan, and Mississippi. A total of 33 160 patients were included in the study among which 13 948 (42%) were discharged to their own homes and 19 212 (58%) were discharged to continue with institutional-based treatment. A multiple logistic regression model showed that gender, age, race, and having ambulatory care-sensitive conditions upon admission were significant predictors of home-based discharges. Females were at higher odds of home discharges in the sample (odds ratio [OR] = 1.631; 95% confidence interval [CI], 1.520-1.751), while patients with ambulatory care-sensitive conditions were less likely to get home discharges (OR = 0.739; 95% CI, 0.684-0.798). As the nation engages in the continued effort to improve the effectiveness of the health care system, cost savings are possible if providers and systems of care are able to identify admission factors with greater prospects for in-home services after discharge.

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“…Frequency and level of engagement with primary care may already be high at this age, especially for those who have complex care needs, thus attending a practice with proactive processes in place may no longer have a considerable impact on outcomes. Other studies have also shown that interpractice variability in ASH rates tends to be smaller at older ages [ 46 ]. This suggests that we may need to carefully approach primary care redesign for older people as we seek to reduce hospital overuse.…”

Section: Discussionmentioning

confidence: 99%

GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

et al. 2020

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Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224.

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Opportunities for primary care to reduce hospital admissions: a cross-sectional study of geographical variation

Cited by 20 publications

References 15 publications

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

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

An Examination of the Likelihood of Home Discharge After General Hospitalizations Among Medicaid Recipients

GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

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