Rates Of Emergency Hospital Admissions Research Articles

Association between inpatient education program for patients with pre-dialysis chronic kidney disease and new-onset cardiovascular disease after initiating dialysis.

The association between inpatient education programs (IEPs) for patients with pre-dialysis chronic kidney disease (CKD) and new-onset cardiovascular disease (CVD) after initiating dialysis is unclear. We conducted a retrospective cohort study between January 1, 2011 and December 31, 2018, evaluating CKD patients who were divided into two groups based on whether or not they participated in IEPs. The primary outcome was a new-onset CVD event after initiating dialysis. Cumulative incidence function was used to describe new-onset CVD considering the competing outcome of death. Additionally, Cox proportional hazards models were used to estimate the hazard ratio of new-onset CVD between IEP and non-IEP groups. Of the 493 patients, 131 (26.6%) patients had participated in IEPs. The IEP group had a significantly longer duration of CKD management by nephrologists (median 142 vs. 115days, P = 0.007), lower rate of emergency hospital admissions (9.9% vs. 27.1%, P < 0.001), better ability to perform activities of daily living (Grade J; 81.6% vs. 69.1%, P = 0.046), higher rate of pre-placement of permanent vascular access or peritoneal dialysis catheters (82.4% vs. 59.4%, P < 0.001), and a higher serum albumin level at the beginning of dialysis (3.5 ± 0.5 vs. 3.3 ± 0.6g/dL, P < 0.001). The cumulative incidence of new-onset CVD at three years after initiating dialysis in the IEP and non-IEP groups was 16.9% and 22.5%, respectively. The hazard ratio for new-onset CVD after initiating dialysis in the IEP group was 0.63 (95% CI: 0.41-0.97, P = 0.036). IEPs were associated with a lower rate of new-onset CVD after initiating dialysis.

Expectations of the Ontario Healthcare System following the Implementation of Ontario Health Teams

With the arrival of Ontario Health Teams (OHTs), healthcare providers, clinicians and patients seek to witness the efficacy of an integrated care model. OHTs are built on the concept of healthcare integration, coordinated care, shared fiscal and clinical accountabilities between multiple healthcare service providers, as well as bridging the gaps between the clinical, social and health promotional aspects of care delivery. This meta-narrative review seeks to examine, compare and determine the efficacy of the integrated care model using cross-sectional studies from around the world to see how integrated care effects health related outcomes. The efficacy of the model will be determined by evaluating the abilities of other integrated care models to reduce healthcare expenditures, improve coordination of care between healthcare service providers, bolster patient satisfaction and health outcomes, minimise emergency and life-threatening cases, lower emergency hospital admission rates as well as provide a comprehensive set of healthcare services including biomedical, mental and social supports. For future applications, this study could be used as a guideline to highlight areas of improvement in integrated care models, as well as to evaluate benefits of existing models and determine best approaches forward.

Identification and Successful Targeting of a Larger Than Expected Health Literacy Gap in Young People with Sickle Cell Disease Transitioning from Pediatric to Adult Care

Young people living with long-term medical conditions growing into adulthood face significant challenges inherent in the necessary new-found autonomy and unprecedented responsibility for their health along with understanding the interfaces with adult health services. Data from the United Kingdom has found that amongst people living with Sickle cell disease (SCD), young adults aged 20-29 years have the highest rates of emergency hospital admissions. This is associated with a significant increase in mortality amongst patients with SCD of this age group. It is well recognized that those who don't understand health information are less likely to seek out healthcare support appropriately and are more likely to have significant ill-health. Furnishing young people with the skills to improve their health literacy is therefore the cornerstone of any transition preparedness programme. Ready Steady Go (RSG) is a UK National Institute of Health and Care Excellence (NICE) endorsed generic transition programme that may be used to support children with long-term conditions. It comprehensively addresses the full range of issues for good transition and facilitates discussion in greater depth of any areas of need to support young people with chronic medical conditions so that they might more effectively manage the needs of their medical condition and navigate entry into adult life with confidence. Data were compared between responses of 147 young people with chronic conditions transitioning to adult care at each of the Ready, Steady and Go timepoints. Age-appropriate questionnaires were offered as part of routine patient care and 4451 unique responses to each of the questions on the age-appropriate RSG questionnaires were obtained including responses related to knowledge and understanding of the condition, its treatment and the composition of the healthcare team, capacity for self-advocacy, assessment of understanding of general adolescent health issues including sexual health, exercise and diet, educational, independence and vocational domains, psychosocial aspects and the understanding of the concept of transitional care. Experience using these questionnaires in clinical practice has taught us that often the questions not answered are at least as informative as those answered as 'need more help' and are often areas with the highest need so we elected to include questions without a response in our evaluation. Analysis revealed that at all stages the young people with SCD (n = 42) were significantly less likely to report confidence in important transition parameters compared to those living with other long-term conditions (n = 105) (figure A). This was most pronounced in questions that assessed knowledge and understanding of their medications and how they worked and ownership of taking their own medications without parental assistance (79.9% SCD vs 89.9% other chronic conditions) with low reported rates of requesting and picking up their own repeat prescriptions (13.9% SCD vs 47.4%) (figure B). Patients with SCD were more likely to report that they needed more help 'dealing with unwelcome comments or bullying' (26.1% SCD vs 3.5%) and less likely to 'feel happy with life' (73.8% SCD vs 86.4%) (figure C). They were also more likely to reply that they did not feel able to 'tell others of their condition' (36.8% SCD vs 11.8%) and were less likely to say that they were 'happy with the way they looked to others' (77.8% SCD vs 86.4%). Our data also suggested that their social support was less with 24% of respondents with SCD saying they did not 'know someone I can talk to when I feel sad or fed up' vs 8.3% of respondents with diabetes. 23.8% of young people with SCD reported they did not see friends outside of school vs 15.5% of young people with diabetes. In response to these data, a bespoke, bite-sized, animated SCD transition education package was developed (figure D). It was offered to young people living with SCD peri-transition and demonstrated an uplift in confidence and understanding from 47.8% to 84.6% after engagement with the resource (figure E). This data analysis and reflexive action research shows that there is a significant health literacy gap in young people with SCD transitioning to adult care, larger than that seen in young people with other chronic conditions and that targeted digital health education interventions are effective at increasing a young person's health literacy, engagement and confidence. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Metastatic melanoma patient outcomes since introduction of immune checkpoint inhibitors in England between 2014 and 2018.

Immune checkpoint inhibitors (CPIs) have radically changed outcomes for patients diagnosed with metastatic melanoma globally in the last 10 years, based on evidence of overall survival (OS) benefits generated from international randomised controlled trials (RCTs). Since RCTs do not always reflect real‐world prescribing, we interrogated established national databases to track prescribing of CPIs approved for first line treatment of metastatic melanoma patients in England since 2014 and determined patient outcomes associated with OS, as well as treatment‐related toxicity. Between April 2014 and March 2018, 5465 melanoma patients were diagnosed and treated with systemic anticancer therapy (SACT), 2322 of which received first‐line CPIs. There was good 3‐year OS concordance with RCT outcomes for ipilimumab (32%), ipinivo (56%) and nivolumab (51%), but OS was lower than expected for pembrolizumab (40%). Comparing patients prescribed ipinivo with those prescribed pembrolizumab, ipinivo‐treated patients were younger (88% vs 49% patients <70 years, P < .001) and fitter (60% vs 38% patients with Eastern Cooperative Oncology Group [ECOG] performance status 0, P < .0001). Emergency hospital admission rates from the earliest and last treatment dates were higher for patients prescribed ipinivo (37% and 55%) compared to those prescribed pembrolizumab (17% and 29%). The 30‐day mortality rates favoured ipinivo patients (3.8% ipinivo, 9.1% pembrolizumab, P < .0001) and likely reflected marked differences in median treatment durations: 63 (range 7‐440) days for ipinivo and 192 (range 5‐943) days for pembrolizumab. The dominant treatment‐related condition linked to hospital admission was colitis, recorded for 25% of patients prescribed ipinivo compared to 4% of patients prescribed pembrolizumab. Our population data has demonstrated that RCT outcomes can be achieved in routine care settings with careful patient selection.

Time Trends in the Diagnosis of Colorectal Cancer With Obstruction, Perforation, and Emergency Admission After the Introduction of Population-Based Organized Screening

Up to 30% of patients with a diagnosis of colorectal cancer (CRC) present as an emergency (an intestinal obstruction, perforation, or emergency hospital admission) (OPE). There are limited data about the association of organized, population-based colorectal cancer screening with the rate of emergency presentations. To examine the association of CRC screening with OPE at cancer diagnosis and time trends in the rate of OPE after the start of organized CRC screening using a highly sensitive fecal occult blood test. A historical cohort study was conducted among 1861 individuals 52 to 74 years of age with a diagnosis of CRC from January 1, 2007, to December 31, 2015, who lived in Winnipeg, Manitoba, a province with universal health care and an organized CRC screening program. Statistical analysis was performed from January 22, 2019, to February 26, 2020. Variables included prior CRC screening, era of diagnosis, cancer stage at diagnosis, tumor site in the colon, area level mean household income, primary care continuity of care, and comorbidity. The primary outcomes were defined as an OPE. Logistic regression was used to evaluate factors associated with OPE at CRC diagnosis. Trends over time were calculated using Joinpoint Regression. From 2007 to 2015, 1861 individuals 52 to 74 years of age (1133 men; median age, 65.1 years [interquartile range, 60.0-70.3 years]) received a diagnosis of CRC in Winnipeg. Most individuals had good continuity of care and moderate comorbidities. Overall, 345 individuals (18.5%) had an OPE. The rate of emergency hospital admissions decreased significantly from 2007 (the start of the organized, province-wide CRC screening program) to 2015 (annual change, -7.1%; 95% CI, -11.3% to -2.8%; P = .01). There was no change in the rate of obstructions or perforations or stage IV CRCs. Individuals who were up to date for CRC screening were significantly less likely to receive a diagnosis of an OPE (odds ratio, 0.38; 95% CI, 0.28-0.50; P < .001). The results were similar after adding emergency department visits and stage IV CRC at diagnosis to the outcome. This study suggests that the rate of emergency hospital admissions decreased over time for individuals who underwent CRC screening, but there was no change in the rate of obstructions and perforations. Individuals who were up to date for CRC screening were less likely to have a CRC diagnosis with an OPE.

Improving FOLFIRINOX safety in pancreatic cancer patients through multidimensional remote monitoring and proactive care using a domomedecine mobile platform.

TPS4673 Background: Pancreatic cancer is a poor prognosis and fast-growing cancer, whose five-year survival is 6% in Europe and the US. FOLFIRINOX has been established as the reference medical treatment for this disease worldwide, yet it also causes leuko-neutropenia, thrombocytopenia, diarrhea, anorexia, asthenia, weight loss, and peripheral sensory neuropathy. Its indication is usually limited to patients having a WHO performance status of 0 or 1. This treatment is often interrupted once Grade 3-4 clinical or hematological toxicities occur, resulting in poor patient performance status and quality of life. Presently, no prospective study monitor and evaluate the qualitative and quantitative effects of FOLFIRINOX on the daily life of pancreatic cancer patients in real-time. Such monitoring would provide early warning signals for the identification of any improvement or deterioration of the patient condition. Whenever necessary, proactive interventions would be triggered to avoid emergency hospitalization for severe adverse events and to enhance treatment compliance. Methods: Our study involves the use of the mobile e-Health platform PiCADo (JMIR 2018) to track and analyse circadian rhythms, symptoms, and body weight in real time in 45 advanced pancreatic cancer patients at 4 centres. The patients are continuously telemonitored for rest-activity, temperature and 3D-orientation via a BLE sensor during the six weeks following the first FOLFIRINOX course. Patients weigh themselves daily on a BLE scale and self-rate their symptoms using a touchscreen on GPRS tablet. Alerts are generated according to preset yet modifiable thresholds of automatically computed critical parameters. From these data, we will evaluate the rate of emergency hospital admissions and the admission-free survival, the rates of severe adverse events, patients’ symptoms dynamics, and their relations with the disruption of the patients’ circadian rhythm. Patient satisfaction and research experience will also be assessed, since engagement is at the core of the success of the approach. The results will guide a future randomized trial comparing standard pancreatic cancer patient care with a personalized FOLFIRINOX approach, including chronotherapy delivery. Support: Ramsay-Sante, Altran.

Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade...

Impact of a community-based cardiovascular disease service intervention in a highly deprived area

ObjectiveTo examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived...

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments

BackgroundRates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement.MethodsThis was a systematic review of systematic reviews. We searched MEDLINE, PubMed, the Cochrane Database of Systematic Reviews & Database of s of Reviews of Effects, Google Scholar and the websites of ten major funding agencies and health charities, using broad search criteria. We included systematic reviews of randomised controlled trials that examined the effect of any medication on emergency hospital admissions among adults. We assessed the quality of reviews using AMSTAR. To prioritise therapies, we assessed the quality of trial evidence underpinning meta-analysed effect estimates and cross-referenced the evidence with clinical guidelines.ResultsWe identified 140 systematic reviews, which included 1968 unique randomised controlled trials and 925,364 patients. Reviews contained 100 medications tested in 47 populations. We identified high-to moderate-quality evidence for 28 medications that reduced admissions. Of these medications, 11 were supported by clinical guidelines in the United States, the United Kingdom and Europe. These 11 therapies were for patients with heart failure (angiotensin-converting-enzyme inhibitors, angiotensin II receptor blockers, aldosterone receptor antagonists and digoxin), stable coronary artery disease (intensive statin therapy), asthma exacerbations (early inhaled corticosteroids in the emergency department and anticholinergics), chronic obstructive pulmonary disease (long-acting muscarinic antagonists and long-acting beta-2 adrenoceptor agonists) and schizophrenia (second-generation antipsychotics and depot/maintenance antipsychotics).ConclusionsWe identified 11 medications supported by strong evidence and clinical guidelines that could be considered in quality monitoring and improvement strategies to help reduce emergency hospital admission rates. The findings are relevant to health systems with a large burden of chronic disease and those managing increasing pressures on acute health-care services.

What is the evidence for the management of patients along the pathway from the emergency department to acute admission to reduce unplanned attendance and admission? An evidence synthesis

BackgroundGlobally, the rate of emergency hospital admissions is increasing. However, little evidence exists to inform the development of interventions to reduce unplanned Emergency Department (ED) attendances and hospital admissions. The objective of this evidence synthesis was to review the evidence for interventions, conducted during the patient’s journey through the ED or acute care setting, to manage people with an exacerbation of a medical condition to reduce unplanned emergency hospital attendance and admissions.MethodsA rapid evidence synthesis, using a systematic literature search, was undertaken in the electronic data bases of MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science, for the years 2000–2014. Evidence included in this review was restricted to Randomised Controlled Trials (RCTs) and observational studies (with a control arm) reported in peer-reviewed journals. Studies evaluating interventions for patients with an acute exacerbation of a medical condition in the ED or acute care setting which reported at least one outcome related to ED attendance or unplanned admission were included.ResultsThirty papers met our inclusion criteria: 19 intervention studies (14 RCTs) and 11 controlled observational studies. Sixteen studies were set in the ED and 14 were conducted in an acute setting. Two studies (one RCT), set in the ED were effective in reducing ED attendance and hospital admission. Both of these interventions were initiated in the ED and included a post-discharge community component. Paradoxically 3 ED initiated interventions showed an increase in ED re-attendance. Six studies (1 RCT) set in acute care settings were effective in reducing: hospital admission, ED re-attendance or re-admission (two in an observation ward, one in an ED assessment unit and three in which the intervention was conducted within 72 h of admission).ConclusionsThere is no clear evidence that specific interventions along the patient journey from ED arrival to 72 h after admission benefit ED re-attendance or readmission. Interventions targeted at high-risk patients, particularly the elderly, may reduce ED utilization and warrant future research. Some interventions showing effectiveness in reducing unplanned ED attendances and admissions are delivered by appropriately trained personnel in an environment that allows sufficient time to assess and manage patients.

G16 Introduction to the well north project and the potential impact on child health

Background The Health of children in the UKis generally worse in the North of England where there are higher levels of child poverty. Evidence demonstrates that early disadvantages track forward, to influence health and development in later life and that children who start behind stay behind. Whitehouse (2014) and Marmot (2010) highlight the complexities and demonstrate a clear correlation between poverty, deprivation and poor health outcomes. Aims The intention of this paper is to introduce a Public Heath England funded project for the North of England called ‘Well North’. The overarching strategic aims of which are to: Improving the health of the poorest fastestReducing levels of worklessness a cause and effect of poor healthReducing premature mortalityImproving health inequalities. Method One of the unique key factors for this project is the engagement of the communities; understanding problem areas and reviewing best practices. Methodologies from the early phase will be presented in this paper. Hot Spot Analysis. Pilot sites from across the region will be identified, within each of the pilot site a hot spot analysis will be undertaken to identify high rates of emergency hospital admissions. When matched against a combination of hospital and council data will identify socially and economically disadvantaged communities. Appreciative Inquiry is a recognised method for studying and changing social systems that builds on the core aspirations that exist within an individual or group seeking to introduce change. Using the method the project team together with local community champions will explore the health attitudes, beliefs and behaviours of residents and multiple agency professionals living and working within these communities, seeking together to identify and implement a range of interventions that will improve the health and wellbeing of residents. Conclusions This paper introduces only the early phase of the project. Ultimately, it is crucial that the end result of the project reduces health inequalities and in doing so produces a model of health and social care delivery that will enable every child to have the best start in life.

Do higher primary care practice performance scores predict lower rates of emergency admissions for persons with serious mental illness? An analysis of secondary panel data

BackgroundSerious mental illness (SMI) is a set of chronic enduring conditions including schizophrenia and bipolar disorder. SMIs are associated with poor outcomes, high costs and high levels of disease burden. Primary care plays a central role in the care of people with a SMI in the English NHS. Good-quality primary care has the potential to reduce emergency hospital admissions, but also to increase elective admissions if physical health problems are identified by regular health screening of people with SMIs. Better-quality primary care may reduce length of stay (LOS) by enabling quicker discharge, and it may also reduce NHS expenditure.ObjectivesWe tested whether or not better-quality primary care, as assessed by the SMI quality indicators measured routinely in the Quality and Outcomes Framework (QOF) in English general practice, is associated with lower rates of emergency hospital admissions for people with SMIs, for both mental and physical conditions and with higher rates of elective admissions for physical conditions in people with a SMI. We also tested the impact of SMI QOF indicators on LOS and costs.DataWe linked administrative data from around 8500 general practitioner (GP) practices and from Hospital Episode Statistics for the study period 2006/7 to 2010/11. We identified SMI admissions by a mainInternational Classification of Diseases, 10th revision (ICD-10) diagnosis of F20–F31. We included information on GP practice and patient population characteristics, area deprivation and other potential confounders such as access to care. Analyses were carried out at a GP practice level for admissions, but at a patient level for LOS and cost analyses.MethodsWe ran mixed-effects count data and linear models taking account of the nested structure of the data. All models included year indicators for temporal trends.ResultsContrary to expectation, we found a positive association between QOF achievement and admissions, for emergency admissions for both mental and physical health. An additional 10% in QOF achievement was associated with an increase in the practice emergency SMI admission rate of approximately 1.9%. There was no significant association of QOF achievement with either LOS or cost. All results were robust to sensitivity analyses.ConclusionsPossible explanations for our findings are (1) higher quality of primary care, as measured by QOF may not effectively prevent the need for secondary care; (2) patients may receive their QOF checks post discharge, rather than prior to admission; (3) people with more severe SMIs, at a greater risk of admission, may select into practices that are better organised to provide their care and which have better QOF performance; (4) better-quality primary care may be picking up unmet need for secondary care; and (5) QOF measures may not accurately reflect quality of primary care. Patient-level data on quality of care in general practice is required to determine the reasons for the positive association of QOF quality and admissions. Future research should also aim to identify the non-QOF measures of primary care quality that may reduce unplanned admissions more effectively and could potentially be incentivised.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study

Objective To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions...

Research into practice: acutely ill children.

Feverish illness is one of the most common reasons for children to consult primary care. Infections account for 40% of all new episodes in general practice, and 29% of all consultations. Childhood infections also continue to have a major impact on secondary care: there has been a 40% increase in the number of children presenting to the emergency department; 14% of children present with febrile illness. Emergency hospital admission rates have increased by 28% from 1999 to 2010, mostly for acute infections. Paradoxically, serious infections have become increasingly rare and are now estimated to constitute <1% of childhood infections presenting to primary care. Serious infections in primary care are dominated by pneumonia, with urinary tract infection in second place, and very few cases now of sepsis, meningitis, or osteomyelitis. While most children suffer from self-limiting illnesses requiring little medical intervention, prompt recognition of the few children with a serious infection is essential to optimise prognosis. The key priority in primary care is therefore deciding whether a child is unwell enough to need immediate referral to hospital, or, whether they can be managed at home. One reason for the increasing pressure on health services is the difficulty in identifying serious infections, especially in the early stages of the disease when signs and symptoms are unspecific. Up to half of children with meningococcal disease are not identified at first contact.1 Symptoms and signs are the first and often only information available to support clinical decision making in primary care. Despite their central role, evidence on their value in primary care settings is surprisingly scarce. Of the 30 diagnostic studies on clinical features for serious infection in children identified in a systematic review, only a single study (of 4000 children in Belgium) was performed in primary care.2 Given that initial assessment …

PMO-245 Infliximab reduces rates of emergency hospital admissions and surgical procedures: a UK retrospective study of Crohn's disease patients

IntroductionCrohn's disease affects 50–100 patients per 100 000 in the population and typically follows a progressive course, with an estimated 33% of patients with active disease developing complications requiring hospitalisation...

Relationships between deprivation and duration of children's emergency admissions for breathing difficulty, feverish illness and diarrhoea in North West England: an analysis of hospital episode statistics

BackgroundIn the United Kingdom there has been a long term pattern of increases in children's emergency admissions and a substantial increase in short stay unplanned admissions. The emergency admission rate (EAR) per thousand population for breathing difficulty, feverish illness and diarrhoea varies substantially between children living in different Primary Care Trusts (PCTs). However, there has been no examination of whether disadvantage is associated with short stay unplanned admissions at PCT-level. The aim of this study was to determine whether differences between emergency hospital admission rates for breathing difficulty, feverish illness and diarrhoea are associated with population-level measures of multiple deprivation and child well-being, and whether there is variation by length of stay and age.MethodsAnalysis of hospital episode statistics and secondary analysis of Index of Multiple Deprivation (IMD) 2007 and Local Index of Child Well-being (CWI) 2009 in ten adjacent PCTs in North West England. The outcome measure for each PCT was the emergency admission rate to hospital for breathing difficulty, feverish illness and diarrhoea.Results23,496 children aged 0-14 were discharged following emergency admission for breathing difficulty, feverish illness and/or diarrhoea during 2006/07. The emergency admission rate ranged from 27.9 to 62.7 per thousand. There were no statistically significant relationships between shorter (0 to 3 day) hospitalisations and the IMD or domains of the CWI. The rate for hospitalisations of 4 or more days was associated with the IMD (Kendall's taub = 0.64) and domains of the CWI: Environment (taub = 0.60); Crime (taub = 0.56); Material (taub = 0.51); Education (taub = 0.51); and Children in Need (taub = 0.51). This pattern was also evident in children aged under 1 year, who had the highest emergency admission rates. There were wide variations between the proportions of children discharged on the day of admission at different hospitals.ConclusionsDifferences between rates of the more common shorter (0 to 3 day) hospitalisations were not explained by deprivation or well-being measured at PCT-level. Indices of multiple deprivation and child well-being were only associated with rates of children's emergency admission for breathing difficulty, feverish illness and diarrhoea for hospitalisations of 4 or more days.

The cost of emergency hospital admissions for falls on snow and ice in England during winter 2009/10: a cross sectional analysis

BackgroundIn the UK, the 2009/10 winter was characterised by sustained low temperatures; grit stocks became depleted and surfaces left untreated. We describe the relationship between temperature and emergency hospital admissions for falls on snow and ice in England, identify the age and gender of those most likely to be admitted, and estimate the inpatient costs of these admissions during the 2009/10 winter.MethodsHospital Episode Statistics were used to identify episodes of emergency admissions for falls on snow and ice during winters 2005/06 to 2009/10; these were plotted against mean winter temperature. By region, the logs of the rates of weekly emergency admissions for falls on snow and ice were plotted against the mean weekly temperature for winters 2005/06 to 2009/10 and a linear regression analysis undertaken. For the 2009/10 winter the number of emergency hospital admissions for falls on snow and ice were plotted by age and gender. The inpatient costs of admissions in the 2009/10 winter for falls on snow and ice were calculated using Healthcare Resource Group costs and Admitted Patient Care 2009/10 National Tariff Information.ResultsThe number of emergency hospital admissions due to falls on snow and ice varied considerably across years; the number was 18 times greater in 2009/10 (N = 16,064) than in 2007/08 (N = 890). There is an exponential increase [Ln(rate of admissions) = 0.456 - 0.463*(mean weekly temperature)] in the rate of emergency hospital admissions for falls on snow and ice as temperature falls. The rate of admissions in 2009/10 was highest among the elderly and particularly men aged 80 and over. The total inpatient cost of falls on snow and ice in the 2009/10 winter was 42 million GBP.ConclusionsEmergency hospital admissions for falls on snow and ice vary greatly across winters, and according to temperature, age and gender. The cost of these admissions in England in 2009/10 was considerable. With responsibility for health improvement moving to local councils, they will have to balance the cost of public health measures like gritting with the healthcare costs associated with falls. The economic burden of falls on snow and ice is substantial; keeping surfaces clear of snow and ice is a public health priority.

Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study

ObjectivesTo identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates.DesignA cross-sectional study.SettingTwo...

Childhood disadvantage and emergency admission rates for common presentations in London: an exploratory analysis

AimTo determine whether emergency hospital admission rates (EAR) for common paediatric conditions in Greater London are associated with measures of child well-being and deprivation.DesignRetrospective analysis of hospital episode statistics and...

Outdoor air pollution, mortality, and hospital admissions from coronary heart disease in Sheffield, UK: a small-area level ecological study

To examine the hypothesis that coronary heart disease mortality and emergency hospital admission rates are higher in areas with higher outdoor air pollution levels. Modelled nitrogen oxides (NO(x)), particulate matter (PM(10)), and carbon monoxide (CO) levels were interpolated to 1030 census enumeration districts using an ecological study design. Results, based on 6857 deaths and 11,407 admissions from 1994-98 and a population of 199,682 aged >or=45 years, were adjusted for age, sex, deprivation, and smoking prevalence. Mortality rate ratios were 1.17 (95% CI 1.06-1.29), 1.08 (95% CI 0.96-1.20), and 1.05 (95% CI 0.95-1.16) in the highest relative to the lowest NO(x), PM(10), and CO quintile categories, respectively. Corresponding admission rate ratios were 1.00 (95% CI 0.90-1.10), 1.01 (95% CI 0.90-1.14), and 0.88 (95% CI 0.79-0.98). The results are consistent with an excess risk of coronary heart disease mortality in areas with high outdoor NO(x), a proxy for traffic-related pollution, but residual confounding cannot be ruled out. If causality were assumed, 6% of coronary heart disease deaths would have been attributable to outdoor NO(x,) and targeting pollution reduction measures at high pollution areas would be an option for coronary mortality prevention.