Rurality and avoidable hospitalization in a Spanish region with high population dispersion

Borda-Olivas, Alfredo; Fernández‐Navarro, Pablo; Otero‐García, Laura; Sanz-Barbero, Belén

doi:10.1093/eurpub/cks163

Cited by 15 publications

(11 citation statements)

References 26 publications

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“…Along a different line, although the distance to a hospital was found to be associated in model 3, a finding consistent with previous research,7 8 25 26 36 the association disappeared when the ACs in the second level were included. This finding is compatible with the fact that distance to a hospital is a good proxy of rurality in Spain, and the distribution of rural versus urban areas in the country is markedly associated with the AC of residence.…”

Section: Discussionsupporting

confidence: 88%

Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

et al. 2017

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ObjectivesPotentially avoidable hospitalisations have been used as a proxy for primary care quality. We aimed to analyse the ecological association between contextual and systemic factors featured in the Spanish healthcare system and the variation in potentially avoidable hospitalisations for a number of chronic conditions.MethodsA cross-section ecological study based on the linkage of administrative data sources from virtually all healthcare areas (n=202) and autonomous communities (n=16) composing the Spanish National Health System was performed. Potentially avoidable hospitalisations in chronic conditions were defined using the Spanish validation of the Agency for Health Research and Quality (AHRQ) preventable quality indicators. Using 2012 data, the ecological association between potentially avoidable hospitalisations and factors featuring healthcare areas and autonomous communities was tested using multilevel negative binomial regression.ResultsIn 2012, 151 468 admissions were flagged as potentially avoidable in Spain. After adjusting for differences in age, sex and burden of disease, the only variable associated with the outcome was hospitalisation intensity for any cause in previous years (incidence risk ratio 1.19 (95% CI 1.13 to 1.26)). The autonomous community of residence explained a negligible part of the residual unexplained variation (variance 0.01 (SE 0.008)). Primary care supply and activity did not show any association.ConclusionsThe findings suggest that the variation in potentially avoidable hospitalisations in chronic conditions at the healthcare area level is a reflection of how intensively hospitals are used in a healthcare area for any cause, rather than of primary care characteristics. Whether other non-studied features at the healthcare area level or primary care level could explain the observed variation remains uncertain.

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Section: Discussionsupporting

confidence: 88%

Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

et al. 2017

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“…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 [10,16,17,39], and health system characteristics [5,31,32,…”

Section: Introductionmentioning

confidence: 99%

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

Wallar

Rosella

2020

PLoS ONE

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Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.

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“…Furthermore, Ogunniyi et al ., in the study in Medicare beneficiaries hospitalized due to HF in Tennessee catchment area, reported that counties with higher HF hospitalization rates were in general those with lower primary care physician to Medicare beneficiaries ratio and that HF hospitalization rates were higher in rural counties. On the other hand, European study investigating potentially avoidable hospitalizations in the Spanish regions of Castile and Leon found the opposite . Patients from different countries have significant differences in HF characteristics and in treatment outcomes as highlighted in this subanalysis of CIBIS‐ELD trial .…”

Section: Discussionmentioning

confidence: 67%

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004–2012

et al. 2019

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AimsHeart failure (HF) burden is displaying significant inter‐regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions.Methods and resultsThe Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004–12. Annual sex and age‐standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co‐morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220–511) and first HF hospitalization (392–721), 30 day (12.6–27.1) and 1 year mortality (66–117), and 30 day (31–80.8) and 1 year readmission (99–24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co‐morbidities.ConclusionsSignificant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients.

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Rurality and avoidable hospitalization in a Spanish region with high population dispersion

Abstract: It is important to determine whether these lower avoidable hospitalization rates reflect an adequate level of accessibility and quality of primary care health services for rural populations or, in the contrary, they reveal access barriers to hospital care.

Cited by 15 publications

References 26 publications

Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

Factors associated with hospitalisations in chronic conditions deemed avoidable: ecological study in the Spanish healthcare system

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

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004–2012

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