Abstract
BackgroundPotentially Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. We estimate the population age-sex standardized relative risk of admission for COPD-PPH by year and area of residence in the Spanish National Health System (sNHS) during the period 2002–2013.MethodsThe study was conducted in the 203 Hospital Service Areas of the sNHS, using the 2002 to 2013 hospital admissions for a COPD-PPH condition of patients aged 20 and over. We use conventional small area variation statistics and a Bayesian hierarchical approach to model the different risk structures of dependence in both space and time.ResultsCOPD-PPH admissions declined from 24.5 to 15.5 per 10,000 persons-year (Men: from 40.6 to 25.1; Women: from 9.1 to 6.4). The relative risk declined from 1.19 (19 % above 2002–2013 average) in 2002 to 0.77 (30 % below average) in 2013. Both the starting point and the slope were different for the different regions. Variation among admission rates between extreme areas dropped from 6.7 times higher in 2002 to 4.6 times higher in 2013.ConclusionsCOPD-PPH conditions in Spain have undergone a strong decline and a reduction in geographical variation in the last 12 years, suggesting a general improvement in health policies and health care over time. Variability among areas still remains, with a substantial room for improvement.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1624-y) contains supplementary material, which is available to authorized users.
Highlights
Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant Potentially Preventable Hospitalizations (PPH)
Continuous and well-organized outpatient care in COPD patients could improve symptoms, reduce severity and avoid hospitalization, most COPD hospital admissions are incorporated into the set of PPH indicators [2], and COPD hospitalizations are one of the most relevant PPH, providing between a third and a half of all cases of chronic PPHs in Spain [3, 4] and Europe [5]
In 2013 the 17 Spanish National Health System (sNHS) regions were organized into 203 hospital service areas (HSA), geographical territories –most of them between 150,000 and 250,000 people– served by one National Health Services (NHS) hospital that provides specialized inpatient and outpatient care to the residents in its area
Summary
Preventable Hospitalizations (PPH) are hospital admissions for conditions which are preventable with timely and appropriate outpatient care being Chronic Obstructive Pulmonary Disease (COPD) admissions one of the most relevant PPH. Preventable Hospitalizations (PPH) are hospital admissions for certain acute illnesses or worsening chronic conditions that may be theoretically preventable with timely and appropriate outpatient care [1, 2]. PPH rely on hospital discharge data but are intended as indirect indicators of accessibility to high-quality outpatient care [3,4,5]. Accessibility to high-quality healthcare can change over time, and with a variable rhythm between areas served by different healthcare organizations. Time trends for COPD-PPH have barely been studied and, to our knowledge, no study has simultaneously analyzed spatial and temporal variability in COPD-PPH
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