Predictors of preventable hospitalizations in an Italian hospital: analysis of administrative data

Abstract

Abstract Background Preventable hospitalizations (PHs) represents less efficiency and low access to outpatient and primary health care. The lengthening of life expectancy and comorbidities that can be treated with primary care are associated with PHs. This study examines the risk of having a PH based on age, gender and comorbidities. Methods We designed a retrospective observational study of admission occurred in a great hospital of the southern of Italy from 2014 to 2019. Composite indicator for PHs were selected using the algorithm proposed by the Agency of Health Research Quality. Any composite indicator (PQI90, PQI91, PQI92) were used as dependent variable of a Poisson model to compute RRs. Comorbidities were decoded as proposed by Charlson et al. in secondary diagnosis. Results A total of 185264 admissions were included in the study, with 11815 (6,37%) PQI90, 2706 (1,46%) PQI91, 9109 (4,91%) PQI92. Age (1.03; CI95%1.03-1.03), cerebrovascular disease (1.33; CI95%1.22-1.44), Chronic obstructive pulmonary disease (COPD) (1.40; CI95%1.30-1.51), diabetes without (1.70; CI95%1.61-1.80) or with (1.83; CI95%1.53-2.18) complications and a mild liver disease (1.76; CI95%1.54-2.00) were associated with PQI90. Age (1.02; CI95%1.02-1.02), cerebrovascular disease (1.60; CI95%1.35-1.90), COPD (1.49; CI95%1.24-1.78), diabetes without complications (1.52; CI95%1.32-1.74) and a mild liver disease (2.87; CI95%2.33-3.54) were associated with PQI91. Age (1.04; CI95%1.04-1.04), cerebrovascular disease (1.26; CI95%1.15-1.39), COPD (1.38; CI95%1.26-1.50), diabetes without (1.76; CI95%1.65-1.87) or with (2.03; CI95%1.68-2.45) complications and a mild liver disease (1.40; CI95%1.18-1.65) were associated with PQI92. Conclusions All indicators of PHs are associated with the increase in age and the presence of common and treatable comorbidities in primary care assets. These indicators are useful for implementing preventive strategies in order to reduce the burden of admission in the hospital setting. Key messages Preventable hospitalizations represent an important portion compared to total hospitalizations. Improvement of primary care strategies are needed to reduce the burden of preventable hospitalizations.