Abstract
The aim of this study was to quantify the burden of avoidable pediatric hospital admissions for Ambulatory care-sensitive conditions (ACSC) and to identify factors related to these preventable hospitalizations. The study was conducted by retrospectively reviewing all medical records of children admitted in a non-teaching 474-bed acute care hospital located in Catanzaro (Italy) for an avoidable hospitalization diagnosis. Two control clinical records involving children hospitalized for clinical conditions not classified as ACSC were randomly selected for each clinical record that included an ACSC. Among the 4293 pediatric hospitalizations, 451 (10.5%) were judged to be preventable. Of these, the most frequent discharge diagnoses were: dehydration (29.7%), pneumonia (17.7%), seizures (15.7%) and chronic obstructive pulmonary disease (12.9%).Children admitted for a preventable hospitalization were more likely to be females, to be younger, to be residents in the same province as the hospital and less likely to have had at least one Community-Based Pediatrician (CBP) access in the previous year and to have used the district health service. The burden of pediatric preventable hospitalizations found in this study is quite high, and the results show that there is still work that lies ahead on the way to improve interaction between hospital and community-based services.
Highlights
Within the last few years there has been a radical change in the healthcare system in Italy, with calls for a more careful use of resources, and an in-depth evaluation of health care performance
All residents are registered with a primary care physician (PCP) when they reach the age of 15 and, before this age, with a community based pediatrician (CBP)
This study represents one of the first Italian attempts to quantify the proportion of pediatric avoidable hospital admissions for Ambulatory care sensitive conditions” (ACSC), to evaluate the extent of the access to primary health care and to describe the relationship between the patient’s socio-demographic profile and health conditions and preventable hospitalizations
Summary
Within the last few years there has been a radical change in the healthcare system in Italy, with calls for a more careful use of resources, and an in-depth evaluation of health care performance. Great attention has been paid to community and primary care services, since a key objective in our health care system is to shift healthcare, whenever appropriate, from acute hospitals to community services [1]. This scenario has prompted the need for indicators measuring quality and performance of community services. More recently it has been suggested that rates of ACSC reflect quality of community-based care, rather than access, in settings with universal health care [3,4,5,6,7,8,9,10,11].
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