Abstract
BackgroundTo reduce hospitalization costs, it is necessary to prevent avoidable hospitalization as well as avoidable readmission. This study aimed to examine the relationship between clinic physician workforce and unplanned readmission for ambulatory care sensitive conditions (ACSCs).MethodsThe present study was a retrospective database research using nationwide administrative claims database of acute care hospitals in Japan. We identified patients aged ≥65 years who were admitted with ACSCs from home and discharged to home between April 2014 and December 2014 (n = 127,209). The primary outcome was unplanned readmission for ACSCs within 30 or 90 days of hospital discharge. A hierarchical logistic regression model was developed with patients at the first level and regions (secondary medical service areas) at the second level.ResultsThe 30-day and 90-day ACSC-related readmission rates were 3.7 and 4.6%, respectively. The high full-time equivalents (FTEs) of clinic physicians per 100,000 population were significantly associated with decreased odds ratios for 30-day and 90-day ACSC-related readmissions. This association did not change even when sensitivity analyses was conducted.ConclusionsAmong patients who had history of admission for ACSCs, greater clinic physician workforce prevented the incidence of readmission because of ACSCs. Regional medical plans to prevent avoidable readmissions should incorporate policy interventions that focus on the clinic physician workforce.
Highlights
To reduce hospitalization costs, it is necessary to prevent avoidable hospitalization as well as avoidable readmission
A systematic review examined the organizational aspects of primary care that contribute to the reduction in avoidable hospitalization; the results showed that adequate supply of primary care physicians and long-term relationship between primary care physicians and patients helped reduce hospitalization for chronic ambulatory care sensitive conditions (ACSCs) [16]
We restricted the target population to patients who regularly visited their clinic after discharge; the results revealed a negative association between full-time equivalents (FTEs) of clinic physicians and readmission for ACSCs
Summary
It is necessary to prevent avoidable hospitalization as well as avoidable readmission. This study aimed to examine the relationship between clinic physician workforce and unplanned readmission for ambulatory care sensitive conditions (ACSCs). The > 65 s account for 60% of the national medical care expenditure [3], and 86% of older adults have at least one chronic disease [4]. Hospitalization costs for chronic diseases and their complications are major contributors to increased medical expenses [5]. A previous study showed that the risk of avoidable hospitalization was higher among individuals who were aged ≥65 years compared. The concept of ambulatory care sensitive conditions (ACSCs) is often used in the context of avoidable hospitalization [7]. ACSCs are defined as conditions for which appropriate outpatient care or early intervention (to prevent complications or more severe disease) can prevent the need for hospitalization [8]. ACSCs include diabetic complications, congestive heart failure, chronic obstructive pulmonary disease, bacterial pneumonia, and urinary tract infections
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