Abstract
BackgroundReducing unplanned hospital admissions is a key priority within the UK and other healthcare systems, however it remains uncertain how this can be achieved. This paper explores the relationship between unplanned ambulatory care sensitive condition (ACSC) admission rates and population, general practice and hospital characteristics. Additionally, we investigated if these factors had a differential impact across 28 conditions.MethodsWe used the English Hospital Episode Statistics to calculate the number of unplanned ACSC hospital admissions for 28 conditions at 8,029 general practices during 2011/12. We used multilevel negative binomial regression to estimate the influence of population (deprivation), general practice (size, access, continuity, quality, A&E proximity) and hospital (bed availability, % day cases) characteristics on unplanned admission rates after adjusting for age, sex and chronic disease prevalence.ResultsPractices in deprived areas (at the 90th centile) had 16% (95% confidence interval: 14 to 18) higher admission rates than those in affluent areas (10th centile). Practices with poorer care continuity (9%; 8 to 11), located closest to A&E (8%; 6 to 9), situated in areas with high inpatient bed availability (14%; 10 to 18) or in areas with a larger proportion of day case admissions (17%; 12 to 21) had more admissions. There were smaller associations for primary care access, clinical quality, and practice size. The strength of associations varied by ACSC. For example, deprivation was most strongly associated with alcohol related diseases and COPD admission rates, while continuity of primary care was most strongly associated with admission rates for chronic diseases such as hypertension and iron-deficiency anaemia.ConclusionsThe drivers of unplanned ACSC admission rates are complex and include population, practice and hospital factors. The importance of these varies markedly across conditions suggesting that multifaceted interventions are required to avoid hospital admissions and reduce costs. Several of the most important drivers of admissions are largely beyond the control of GPs. However, strategies to improve primary care continuity and avoid unnecessary short-stay admissions could lead to improved efficiency.
Highlights
Reducing unplanned hospital admissions is a key priority within the UK and other healthcare systems, it remains uncertain how this can be achieved
We investigated the effect of population, general practice and hospital characteristics on unplanned admission rates
Descriptive statistics There were 1.77 million admissions for ambulatory care sensitive condition (ACSC) accounting for 10.9 million bed days during 2011/2 (Table 1)
Summary
Reducing unplanned hospital admissions is a key priority within the UK and other healthcare systems, it remains uncertain how this can be achieved. This paper explores the relationship between unplanned ambulatory care sensitive condition (ACSC) admission rates and population, general practice and hospital characteristics. Knowledge of how population (e.g. deprivation), general practice (e.g. quality) and hospital (e.g. bed availability) characteristics influence admission rates could aid the identification of poorer quality care, help redesign services, develop admission avoidance interventions, and yield financial savings for the NHS. Currently this evidence is only available for a minority of ACSCs and is often impaired by poor generalisability, a lack of case-mix adjustment and other methodological weaknesses [9, 10]
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