Abstract
BackgroundAvoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care. We examine regional variation of AH in Switzerland and the factors that determine AH.MethodsWe used hospital service areas, and data from 2008–2010 hospital discharges in Switzerland to examine regional variation in AH. Age and sex standardized AH were the outcome variable, and year of admission, primary care physician density, medical specialist density, rurality, hospital bed density and type of hospital reimbursement system were explanatory variables in our multilevel poisson regression.ResultsRegional differences in AH were as high as 12-fold. Poisson regression showed significant increase of all AH over time. There was a significantly lower rate of all AH in areas with more primary care physicians. Rates increased in areas with more specialists. Rates of all AH also increased where the proportion of residences in rural communities increased. Regional hospital capacity and type of hospital reimbursement did not have significant associations. Inconsistent patterns of significant determinants were found for disease specific analyses.ConclusionThe identification of regions with high and low AH rates is a starting point for future studies on unwarranted medical procedures, and may help to reduce their incidence. AH have complex multifactorial origins and this study demonstrates that rurality and physician density are relevant determinants. The results are helpful to improve the performance of the outpatient sector with emphasis on local context. Rural and urban differences in health care delivery remain a cause of concern in Switzerland.
Highlights
Avoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care
Avoidable hospitalizations (AH), referred to as hospitalizations for ambulatory care sensitive conditions (ACSC) are hospital admissions for diseases and conditions that might have been avoided if better ambulatory care were available [1]
For geographic analyses we summarized the data at two levels and developed statistical models to explore the relationship between rates of AH and characteristics of regional supply of medical care
Summary
Avoidable hospitalizations (AH) are hospital admissions for diseases and conditions that could have been prevented by appropriate ambulatory care. Avoidable hospitalizations (AH), referred to as hospitalizations for ambulatory care sensitive conditions (ACSC) are hospital admissions for diseases and conditions that might have been avoided if better ambulatory care were available [1]. AH are indicators of access and quality of ambulatory care and have been used to monitor. Structural deficits of care provision such as inequitable access across different societal groups, e.g. urban rural differences, racial and ethnic minorities or different levels of health insurance coverage were identified mainly in the US literature as important predictors of AH’s [12,13]; but AH can be seen as an indicator of process quality resulting in medical procedures not warranted by effective needs [14]. Switzerland is an OECD country with among the highest per capita availability of physicians and nurses and it has one of the world’s highest life expectancies [17]
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