Abstract
ObjectivesPotentially avoidable hospital admissions (PAAs) are costly to health services and potentially harmful for patients. This study aimed to compare area-level PAA rates among people using and not using secondary mental health services in England and to identify health system features that may influence between-area PAA variation.MethodsNational ecological study using linked English hospital admissions and secondary mental health services data (2016–2018). We calculated two-year average age-sex standardised area-level PAA rates according to primary admission diagnoses for 12 physical conditions, among, first, secondary mental health service users with any non-organic diagnosis, and, second, people not in contact with secondary mental health services. We used penalised regression analyses to identify predictors of area-level variation in PAA rates.ResultsArea-level PAA rates were over four times greater in the mental health group, at 7,594 per 100,000 population compared to 1,819 per 100,000 in the comparator group. Common predictors of variation were greater density of older age groups (lower PAA rates), higher underlying population morbidity of chronic obstructive pulmonary disease and, to a lesser extent, urbanity (higher PAA rates). For both groups, health system factors such as the number of general practitioners per capita or ambulance despatch rates were significant but weak predictors of variation. Mental health diagnosis data were available for half of secondary mental health care records only and sensitivity analyses found that urbanity remained the sole significant predictor for PAAs in this group.ConclusionsFindings support the need for improved management of physical conditions for secondary mental health service users. Understanding and predicting variation in PAAs among mental health service users is constrained by availability of data on mental health diagnosis, physical health care and needs.
Highlights
Avoidable admissions (PAAs) refer to admissions for conditions that could be managed outside hospital through appropriate care.[1]
Deprivation levels are largely outside the control of those purchasing or delivering health and care services, and it is important to identify those health system factors that are associated with Potentially avoidable admissions (PAAs) and that are amenable to intervention to inform targeting of initiatives to reduce such admissions
This study found area-level rates of potentially avoidable hospital admissions (PAAs) in England to be four times greater among secondary mental health service users with any psychotic or non-psychotic mental health condition than people not using secondary mental health services
Summary
Avoidable admissions (PAAs) refer to admissions for conditions that could be managed outside hospital through appropriate care.[1] PAAs are costly to health services and may adversely affect patients’ wellbeing. (ED)[4,5] and experience higher PAA rates than the general population.[4,6] This is likely due to greater risk of morbidity or multimorbidity and premature mortality, predominantly linked to physical conditions.[7,8] People with mental health problems may be at particular risk of incurring harm through unplanned hospital visits and PAA because ED staff may lack adequate skills to provide appropriate and nonstigmatising care.[9]. Deprivation levels are largely outside the control of those purchasing or delivering health and care services, and it is important to identify those health system factors that are associated with PAA and that are amenable to intervention to inform targeting of initiatives to reduce such admissions
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