Abstract
BackgroundPotentially preventable hospital admission (an admission deemed to be potentially preventable given appropriate care in the community-based healthcare setting) has been a topic of international research attention for almost three decades. Recently this has been largely driven by the imperative to reduce ever-increasing unplanned hospital admissions. However, identifying potentially preventable admissions is difficult. As a result, the population level indicator of admissions for ambulatory care sensitive conditions (ACSCs) has been used as a proxy measure for potentially preventable admission. The adoption of this measure has become common, and in Australia, the rate of admissions for chronic ACSCs is now an important component of measuring health system performance and accountability, and is directly linked to funding. Admission for a chronic ACSC is also used to identify individuals for targeting of interventions to reduce preventable admissions.DiscussionHospital admission for chronic ACSCs is a population measure based on admission diagnoses, it therefore should not be used to identify individual preventable admissions. At present we are unable to determine individual admissions that are deemed to be preventable or, therefore, articulate the factors associated with admissions which are preventable.SummaryAs we are currently unable to identify individual admissions that are preventable, little is understood about the underlying causes and factors contributing to preventable admissions. A means of assessing preventability of individual admissions is required. Only then can we explore the antecedents, and patient and clinician perspectives on preventable admissions. Until we have a clearer understanding of this, our capacity to inform policy and program development remains compromised.
Highlights
Preventable hospital admission has been a topic of international research attention for almost three decades
Policy development and program design, one well-used proxy measure for potentially preventable admissions is admissions for “ambulatory care sensitive conditions” (ACSC), a concept first introduced in New York in the early 1990s as an Longman et al BMC Health Services Research (2015) 15:472 indicator of population level access to outpatient care [1]
In Australia the rate of ACSCs is an important component of measuring health system performance and accountability [4], and variation in rates of ACSC admissions are assumed to reflect variation in access to, or quality of, community-based care
Summary
Difficulties with using admissions for ambulatory care sensitive conditions to identify potentially preventable admissions The number of admissions for chronic ACSCs is a population level measure based on specific admission diagnoses and cannot assess the preventability of individual admissions. It is not possible to explore how the preventability of individual admissions varies across different population groups or in different contexts Put together, this means we have limited evidence for developing and targeting interventions to reduce preventable admissions. Some evidence exists showing that community-based healthcare interventions targeting patients with specific chronic ACSCs can result in reductions in admissions for COPD and asthma [9,10,11,12] This suggests that some admissions may be preventable with improved community-based services, few studies have used hospital admission as an outcome measure and generally the evidence for interventions in communitybased healthcare settings is too limited to draw any conclusions [13]. The evidence to support this assumption is limited, with two recent large trials finding no impact of care coordination on the use of acute care [31, 32]
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