Abstract
BackgroundAs many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Benchmarking is a valuable tool to identify areas for improvement. Prior work indicates that chronic care coordination is poor in the DHS, especially in comparison with care in Kaiser Permanente (KP), an integrated delivery system based in the United States. We investigated population rates of hospitalisation and readmission rates for ambulatory care sensitive, chronic medical conditions in the two systems.MethodsUsing a historical cohort study design, age and gender adjusted population rates of hospitalisations for angina, heart failure, chronic obstructive pulmonary disease, and hypertension, plus rates of 30-day readmission and mortality were investigated for all individuals aged 65+ in the DHS and KP.ResultsDHS had substantially higher rates of hospitalisations, readmissions, and mean lengths of stay per hospitalisation, than KP had. For example, the adjusted angina hospitalisation rates in 2007 for the DHS and KP respectively were 1.01/100 persons (95%CI: 0.98-1.03) vs. 0.11/100 persons (95%CI: 0.10-0.13/100 persons); 21.6% vs. 9.9% readmission within 30 days (OR = 2.53; 95% CI: 1.84-3.47); and mean length of stay was 2.52 vs. 1.80 hospital days. Mortality up through 30 days post-discharge was not consistently different in the two systems.ConclusionsThere are substantial differences between the DHS and KP in the rates of preventable hospitalisations and subsequent readmissions associated with chronic conditions, which suggest much opportunity for improvement within the Danish healthcare system. Reductions in hospitalisations also could improve patient welfare and free considerable resources for use towards preventing disease exacerbations. These conclusions may also apply for similar public systems such as the US Medicare system, the NHS and other systems striving to improve the integration of care for persons with chronic conditions.
Highlights
As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts
Kaiser Permanente (KP) has been highlighted as a successful model of integrated and cost-effective care and prior work has found that the Northern California Region of KP had fewer hospital admissions for chronic diseases compared to the National Health Service (NHS) [16]
We focus on hospitalisations for ambulatory care sensitive conditions (ACSCs) for five selected chronic medical conditions: angina, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes mellitus (DM), and hypertension (HTN)
Summary
As many other European healthcare systems the Danish healthcare system (DHS) has targeted chronic condition care in its reform efforts. Previous research suggests that these events can be sensitive to the quality and amount of prior care, the rates of hospitalisations or readmissions when there is an initial hospitalisation, provide information on medical quality, including on the level of care coordination for patients with these complex conditions [4,5,6,7,8,9,10]. High numbers of hospitalisations for ambulatory care sensitive conditions (ACSCs) have been identified in a number of European countries, as well as among subpopulations in the United States with known problems with care such as patients without healthcare insurance or who receive care in highly fragmented systems [11,12,13,14]. More recent research have indicated substantially poorer care coordination during transitions from hospital to primary care providers in the Danish Healthcare System (DHS), compared to KP [17]
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