1
|
Rosella LC, Hurst M, O'Neill M, Pagalan L, Diemert L, Kornas K, Hong A, Fisher S, Manuel DG. A study protocol for a predictive model to assess population-based avoidable hospitalization risk: Avoidable Hospitalization Population Risk Prediction Tool (AvHPoRT). Diagn Progn Res 2024; 8:2. [PMID: 38317268 PMCID: PMC10845544 DOI: 10.1186/s41512-024-00165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION Avoidable hospitalizations are considered preventable given effective and timely primary care management and are an important indicator of health system performance. The ability to predict avoidable hospitalizations at the population level represents a significant advantage for health system decision-makers that could facilitate proactive intervention for ambulatory care-sensitive conditions (ACSCs). The aim of this study is to develop and validate the Avoidable Hospitalization Population Risk Tool (AvHPoRT) that will predict the 5-year risk of first avoidable hospitalization for seven ACSCs using self-reported, routinely collected population health survey data. METHODS AND ANALYSIS The derivation cohort will consist of respondents to the first 3 cycles (2000/01, 2003/04, 2005/06) of the Canadian Community Health Survey (CCHS) who are 18-74 years of age at survey administration and a hold-out data set will be used for external validation. Outcome information on avoidable hospitalizations for 5 years following the CCHS interview will be assessed through data linkage to the Discharge Abstract Database (1999/2000-2017/2018) for an estimated sample size of 394,600. Candidate predictor variables will include demographic characteristics, socioeconomic status, self-perceived health measures, health behaviors, chronic conditions, and area-based measures. Sex-specific algorithms will be developed using Weibull accelerated failure time survival models. The model will be validated both using split set cross-validation and external temporal validation split using cycles 2000-2006 compared to 2007-2012. We will assess measures of overall predictive performance (Nagelkerke R2), calibration (calibration plots), and discrimination (Harrell's concordance statistic). Development of the model will be informed by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement. ETHICS AND DISSEMINATION This study was approved by the University of Toronto Research Ethics Board. The predictive algorithm and findings from this work will be disseminated at scientific meetings and in peer-reviewed publications.
Collapse
Affiliation(s)
- Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada.
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- ICES, Toronto, ON, M4N 3M5, Canada.
| | - Mackenzie Hurst
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
- ICES, Toronto, ON, M4N 3M5, Canada
| | - Meghan O'Neill
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Lief Pagalan
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Lori Diemert
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
| | - Andy Hong
- PEAK Urban Research Programme, Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
- Department of City & Metropolitan Planning, University of Utah, Salt Lake City, UT, USA
- The George Institute for Global Health, Newtown, NSW, Australia
| | - Stacey Fisher
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Sciences Building 6th Floor, Toronto, ON, M5T 3M7, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, Canada
- Statistics Canada, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
| |
Collapse
|
2
|
Kovacevic L, Naik R, Lugo-Palacios DG, Ashrafian H, Mossialos E, Darzi A. The impact of collaborative organisational models and general practice size on patient safety and quality of care in the English National Health Service: A systematic review. Health Policy 2023; 138:104940. [PMID: 37976620 DOI: 10.1016/j.healthpol.2023.104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
Collaborative primary care has become an increasingly popular strategy to manage existing pressures on general practice. In England, the recent changes taking place in the primary care sector have included the formation of collaborative organisational models and a steady increase in practice size. The aim of this review was to summarise the available evidence on the impact of collaborative models and general practice size on patient safety and quality of care in England. We searched for quantitative and qualitative studies on the topic published between January 2010 and July 2023. The quality of articles was assessed using the Newcastle-Ottawa Scale and the Critical Appraisal Skills Programme checklist. We screened 6533 abstracts, with full-text screening performed on 76 records. A total of 29 articles were included in the review. 19 met the inclusion criteria following full-text screening, with seven identified through reverse citation searching and three through expert consultation. All studies were found to be of moderate or high quality. A predominantly positive impact on service delivery measures and patient-level outcomes was identified. Meanwhile, the evidence on the effect on pay-for-performance outcomes and hospital admissions is mixed, with continuity of care and access identified as a concern. While this review is limited to evidence from England, the findings provide insights for all health systems undergoing a transition towards collaborative primary care.
Collapse
Affiliation(s)
- Lana Kovacevic
- NIHR Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, Queen Elizabeth Queen Mother Wing, St Mary's Hospital, South Wharf Road, W2 1NY, London, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, W2 1NY, London, UK.
| | - Ravi Naik
- Institute of Global Health Innovation, Imperial College London, Faculty Building, South Kensington Campus, Kensington, SW7 2AZ, London, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, W2 1NY, London, UK
| | - David G Lugo-Palacios
- Institute of Global Health Innovation, Imperial College London, Faculty Building, South Kensington Campus, Kensington, SW7 2AZ, London, UK; Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, Faculty Building, South Kensington Campus, Kensington, SW7 2AZ, London, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, W2 1NY, London, UK
| | - Elias Mossialos
- Institute of Global Health Innovation, Imperial College London, Faculty Building, South Kensington Campus, Kensington, SW7 2AZ, London, UK; Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, Faculty Building, South Kensington Campus, Kensington, SW7 2AZ, London, UK; Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, W2 1NY, London, UK
| |
Collapse
|
3
|
Launders N, Hayes JF, Price G, Marston L, Osborn DPJ. The incidence rate of planned and emergency physical health hospital admissions in people diagnosed with severe mental illness: a cohort study. Psychol Med 2023; 53:5603-5614. [PMID: 36069188 PMCID: PMC10482715 DOI: 10.1017/s0033291722002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have more physical health conditions than the general population, resulting in higher rates of hospitalisations and mortality. In this study, we aimed to determine the rate of emergency and planned physical health hospitalisations in those with SMI, compared to matched comparators, and to investigate how these rates differ by SMI diagnosis. METHODS We used Clinical Practice Research DataLink Gold and Aurum databases to identify 20,668 patients in England diagnosed with SMI between January 2000 and March 2016, with linked hospital records in Hospital Episode Statistics. Patients were matched with up to four patients without SMI. Primary outcomes were emergency and planned physical health admissions. Avoidable (ambulatory care sensitive) admissions and emergency admissions for accidents, injuries and substance misuse were secondary outcomes. We performed negative binomial regression, adjusted for clinical and demographic variables, stratified by SMI diagnosis. RESULTS Emergency physical health (aIRR:2.33; 95% CI 2.22-2.46) and avoidable (aIRR:2.88; 95% CI 2.60-3.19) admissions were higher in patients with SMI than comparators. Emergency admission rates did not differ by SMI diagnosis. Planned physical health admissions were lower in schizophrenia (aIRR:0.80; 95% CI 0.72-0.90) and higher in bipolar disorder (aIRR:1.33; 95% CI 1.24-1.43). Accident, injury and substance misuse emergency admissions were particularly high in the year after SMI diagnosis (aIRR: 6.18; 95% CI 5.46-6.98). CONCLUSION We found twice the incidence of emergency physical health admissions in patients with SMI compared to those without SMI. Avoidable admissions were particularly elevated, suggesting interventions in community settings could reduce hospitalisations. Importantly, we found underutilisation of planned inpatient care in patients with schizophrenia. Interventions are required to ensure appropriate healthcare use, and optimal diagnosis and treatment of physical health conditions in people with SMI, to reduce the mortality gap due to physical illness.
Collapse
Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F. Hayes
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Gabriele Price
- Department of Health and Social Care, Office for Health Improvement and Disparities, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Louise Marston
- Department of Primary Care and Population Health, UCL, Rowland Hill Street, NW3 2PF, London, UK
| | - David P. J. Osborn
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| |
Collapse
|
4
|
Satokangas M, Arffman M, Agerholm J, Thielen K, Hougaard CØ, Andersen I, Burström B, Keskimäki I. Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000-2015. BMC Health Serv Res 2023; 23:835. [PMID: 37550672 PMCID: PMC10405465 DOI: 10.1186/s12913-023-09855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000-2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. METHODS We acquired individual level ACSCs for those aged ≥ 45 in 2000-2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45-64, 65-75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. RESULTS Copenhagen had the highest IRR of ACSCs among those aged 45-64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) - with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. CONCLUSIONS While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
Collapse
Affiliation(s)
- Markku Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Martti Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ørsted Hougaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, 33014, Tampere, Finland
| |
Collapse
|
5
|
Schulte T, Wurz T, Groene O, Bohnet-Joschko S. Big Data Analytics to Reduce Preventable Hospitalizations-Using Real-World Data to Predict Ambulatory Care-Sensitive Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4693. [PMID: 36981600 PMCID: PMC10049041 DOI: 10.3390/ijerph20064693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/01/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to develop a prediction model to identify individuals and populations with a high risk of being hospitalized due to an ambulatory care-sensitive condition who might benefit from preventative actions or tailored treatment options to avoid subsequent hospital admission. A rate of 4.8% of all individuals observed had an ambulatory care-sensitive hospitalization in 2019 and 6389.3 hospital cases per 100,000 individuals could be observed. Based on real-world claims data, the predictive performance was compared between a machine learning model (Random Forest) and a statistical logistic regression model. One result was that both models achieve a generally comparable performance with c-values above 0.75, whereas the Random Forest model reached slightly higher c-values. The prediction models developed in this study reached c-values comparable to existing study results of prediction models for (avoidable) hospitalization from the literature. The prediction models were designed in such a way that they can support integrated care or public and population health interventions with little effort with an additional risk assessment tool in the case of availability of claims data. For the regions analyzed, the logistic regression revealed that switching to a higher age class or to a higher level of long-term care and unit from prior hospitalizations (all-cause and due to an ambulatory care-sensitive condition) increases the odds of having an ambulatory care-sensitive hospitalization in the upcoming year. This is also true for patients with prior diagnoses from the diagnosis groups of maternal disorders related to pregnancy, mental disorders due to alcohol/opioids, alcoholic liver disease and certain diseases of the circulatory system. Further model refinement activities and the integration of additional data, such as behavioral, social or environmental data would improve both model performance and the individual risk scores. The implementation of risk scores identifying populations potentially benefitting from public health and population health activities would be the next step to enable an evaluation of whether ambulatory care-sensitive hospitalizations can be prevented.
Collapse
Affiliation(s)
- Timo Schulte
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
- Department of Business Analytics, Clinics of Maerkischer Kreis, 58515 Luedenscheid, Germany
| | - Tillmann Wurz
- Department of Project and Change Management, University Clinic Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Oliver Groene
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Department of Research & Innovation, OptiMedis AG, 20095 Hamburg, Germany
| | - Sabine Bohnet-Joschko
- Faculty of Management, Economics and Society, Witten/Herdecke University, 58455 Witten, Germany
- Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| |
Collapse
|
6
|
Lee WR, Koo JH, Jeong JY, Kim MS, Yoo KB. Regional Health Disparities in Hypertension-Related Hospitalization of Hypertensive Patients: A Nationwide Population-Based Nested Case-Control Study. Int J Public Health 2023; 68:1605495. [PMID: 36762122 PMCID: PMC9902356 DOI: 10.3389/ijph.2023.1605495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
Objective: This study aims to explore regional health disparities in hypertension-related hospitalizations and confirm this difference according to the states of continuity of care (COC). Methods: We used the National Health Insurance Service National Sample Cohort data from 2002 to 2019. The dependent variable, hypertension-related hospitalization, included hospitalization for hypertensive diseases (I10-I13, I15), ischemic heart disease (I20-I25), and cerebrovascular disease (I60-I69). Nested case-control matching was performed according to age, sex, and income level. We compared hypertension-related hospitalization fractions in urban and rural areas by classifying them according to the state of COC and analyzed them using conditional logistic regression suitable for matched data. Results: The odds of hypertension-related hospitalization of hypertensive patients were higher in the rural areas than in the urban areas; however, as the COC increased, the difference decreased. There was no change in the results according to the COC observation period. Conclusion: To reduce regional health disparities, both the promotion of COC and the improvement of the quality of primary care must be achieved.
Collapse
Affiliation(s)
- Woo-Ri Lee
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic ofKorea
| | - Jun Hyuk Koo
- HIRA Research Institute, Health Insurance Review & Assessment Service (HIRA), Wonju, Republic ofKorea
| | - Ji Yun Jeong
- Gangwon Public Health Policy Institute, Chuncheon, Republic ofKorea
| | - Min Su Kim
- HIRA Research Institute, Health Insurance Review & Assessment Service (HIRA), Wonju, Republic ofKorea
| | - Ki-Bong Yoo
- Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Wonju, Republic ofKorea,*Correspondence: Ki-Bong Yoo,
| |
Collapse
|
7
|
Schuettig W, Sundmacher L. The impact of ambulatory care spending, continuity and processes of care on ambulatory care sensitive hospitalizations. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1329-1340. [PMID: 35091856 PMCID: PMC9550748 DOI: 10.1007/s10198-022-01428-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/06/2022] [Indexed: 06/14/2023]
Abstract
Ambulatory care sensitive hospitalizations are widely considered as important measures of access to as well as quality and performance of primary care. In our study, we investigate the impact of spending, process quality and continuity of care in the ambulatory care sector on ambulatory care sensitive hospitalizations in patients with type 2 diabetes. We used observational data from Germany's major association of insurance companies from 2012 to 2014 with 55,924 patients, as well as data from additional sources. We conducted negative binomial regression analyses with random effects at the district level. To control for potential endogeneity of spending and physician density in the ambulatory care sector, we used an instrumental variable approach. We controlled for a wide range of covariates, such as age, sex, and comorbidities. The results of our analysis suggest that spending in the ambulatory care sector has weak negative effects on ambulatory care sensitive hospitalizations. We also found that continuity of care was negatively associated with hospital admissions. Patients with type 2 diabetes are at increased risk of hospitalization resulting from ambulatory care sensitive conditions. Our study provides some evidence that increased spending and improved continuity of care while controlling for process quality in the ambulatory care sector may be effective ways to reduce the rate of potentially avoidable hospitalizations among patients with type 2 diabetes.
Collapse
Affiliation(s)
- Wiebke Schuettig
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| |
Collapse
|
8
|
Yi SE, Harish V, Gutierrez J, Ravaut M, Kornas K, Watson T, Poutanen T, Ghassemi M, Volkovs M, Rosella LC. Predicting hospitalisations related to ambulatory care sensitive conditions with machine learning for population health planning: derivation and validation cohort study. BMJ Open 2022; 12:e051403. [PMID: 35365510 PMCID: PMC8977821 DOI: 10.1136/bmjopen-2021-051403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/28/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To predict older adults' risk of avoidable hospitalisation related to ambulatory care sensitive conditions (ACSC) using machine learning applied to administrative health data of Ontario, Canada. DESIGN, SETTING AND PARTICIPANTS A retrospective cohort study was conducted on a large cohort of all residents covered under a single-payer system in Ontario, Canada over the period of 10 years (2008-2017). The study included 1.85 million Ontario residents between 65 and 74 years old at any time throughout the study period. DATA SOURCES Administrative health data from Ontario, Canada obtained from the (ICES formely known as the Institute for Clinical Evaluative Sciences Data Repository. MAIN OUTCOME MEASURES Risk of hospitalisations due to ACSCs 1 year after the observation period. RESULTS The study used a total of 1 854 116 patients, split into train, validation and test sets. The ACSC incidence rates among the data points were 1.1% for all sets. The final XGBoost model achieved an area under the receiver operating curve of 80.5% and an area under precision-recall curve of 0.093 on the test set, and the predictions were well calibrated, including in key subgroups. When ranking the model predictions, those at the top 5% of risk as predicted by the model captured 37.4% of those presented with an ACSC-related hospitalisation. A variety of features such as the previous number of ambulatory care visits, presence of ACSC-related hospitalisations during the observation window, age, rural residence and prescription of certain medications were contributors to the prediction. Our model was also able to capture the geospatial heterogeneity of ACSC risk in Ontario, and especially the elevated risk in rural and marginalised regions. CONCLUSIONS This study aimed to predict the 1-year risk of hospitalisation from ambulatory-care sensitive conditions in seniors aged 65-74 years old with a single, large-scale machine learning model. The model shows the potential to inform population health planning and interventions to reduce the burden of ACSC-related hospitalisations.
Collapse
Affiliation(s)
- Seung Eun Yi
- Layer6 AI, Toronto, Ontario, Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Vinyas Harish
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | - Mathieu Ravaut
- School of Computer Science and Engineering, Nanyang Technological University, Singapore
| | - Kathy Kornas
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tristan Watson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Marzyeh Ghassemi
- Department of Computer Science, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
| | | | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine, University of Toronto, Toronto, Ontario, Canada
- Vector Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| |
Collapse
|
9
|
Daykan Y, Tamir Yaniv R, Yagur Y, Pomeranz M, Arbib N, Klein Z, Schonman R. Did COVID-19 quarantine redirect habitual patient visits in the gynecology emergency room? J Gynecol Obstet Hum Reprod 2021; 50:102199. [PMID: 34329799 PMCID: PMC8314788 DOI: 10.1016/j.jogoh.2021.102199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/01/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022]
Abstract
Objective COVID-19 pandemic caused a dramatic decline in the gynecology emergency department (ED) visits. The Israeli government took a determined step of quarantine to suppress and control the spread. This study evaluates the effect of the COVID -19 quarantine on gynecology emergency department (ED) visits compared to the previous year. Materials and methods A retrospective case-control study was conducted during the first half-year of the COVID-19 pandemic and focused on the quarantine during April. In order to identify differences in the population's epidemiology and changes in the amount and type of emergency gynecological visits and surgeries, we compared patients during April 2020 (COVID-19 quarantine) to those who visited the gynecology ED during April 2019. Results During January–June 2020 period, there was an overall 3707 patient visits in the gynecology ED, which represents a 22.8% decrease in patient visits compared to the previous year (2019, 4803 patients). There was a 36% decrease in the gynecology ED visits during the quarantine period. Patient demographics were similar between groups. Visits of nulliparous women were more common in the study group (p = .0001) and self-referral (p = .017). More post-operative complications and fewer patients with abdominal pain were admitted to the study group (p = .034 and p = .054, respectively). During the study, the hospitalization rate did not change 18.2% vs. 17.5% (p = 0.768). Hospitalization duration was significantly longer in the COVID-19 quarantine (2.8 ± 1.3 vs. 3.1 ± 1.5, p < 0.001). There was no significant difference among surgical procedure incidents. Conclusion Visits in the gynecology ED service decreased during the COVID-19 quarantine without compromising the treatment of gynecology emergencies. Many gynecologic complaints can be managed in community care settings without referral to an ED.
Collapse
Affiliation(s)
- Yair Daykan
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel.
| | - Rina Tamir Yaniv
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Yael Yagur
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Meir Pomeranz
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Zvi Klein
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| | - Ron Schonman
- Department of Obstetrics and Gynecology , Meir Medical Center, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv , Israel
| |
Collapse
|
10
|
Moss C, Sutton M, Cheraghi-Sohi S, Sanders C, Allen T. Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018. BMJ Open 2021; 11:e049811. [PMID: 34312208 PMCID: PMC8314693 DOI: 10.1136/bmjopen-2021-049811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES People experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics. DESIGN Retrospective matched cohort study. SETTING Hospitals in England. PARTICIPANTS 16 161 homeless patients and 74 780 housed patients aged 16-75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis. PRIMARY AND SECONDARY OUTCOME MEASURES Annual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015-2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients. RESULTS Mean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina. CONCLUSIONS Homeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.
Collapse
Affiliation(s)
- Charlie Moss
- Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sudeh Cheraghi-Sohi
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
11
|
Eyles E, Redaniel MT, Purdy S, Tilling K, Ben-Shlomo Y. Associations of GP practice characteristics with the rate of ambulatory care sensitive conditions in people living with dementia in England: an ecological analysis of routine data. BMC Health Serv Res 2021; 21:613. [PMID: 34182996 PMCID: PMC8240405 DOI: 10.1186/s12913-021-06634-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital admissions for Ambulatory Care Sensitive Conditions (ACSCs) are potentially avoidable. Dementia is one of the leading chronic conditions in terms of variability in ACSC admissions by general practice, as well as accounting for around a third of UK emergency admissions. METHODS Using Bayesian multilevel linear regression models, we examined the ecological association of organizational characteristics of general practices (ACSC n=7076, non-ACSC n=7046 units) and Clinical Commissioning Groups (CCG n=212 units) in relation to ACSC and non-ACSC admissions for people with dementia in England. RESULTS The rate of hospital admissions are variable between GP practices, with deprivation and being admitted from home as risk factors for admission for ACSC and non-ACSC admissions. The budget allocated by the CCG to mental health shows diverging effects for ACSC versus non-ACSC admissions, so it is likely there is some geographic variation. CONCLUSIONS A variety of factors that could explain avoidable admissions for PWD at the practice level were examined; most were equally predictive for avoidable and non-avoidable admissions. However, a high amount of variation found at the practice level, in conjunction with the diverging effects of the CCG mental health budget, implies that guidance may be applied inconsistently, or local services may have differences in referral criteria. This indicates there is potential scope for improvement.
Collapse
Affiliation(s)
- Emily Eyles
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK. .,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK.
| | - Maria Theresa Redaniel
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Sarah Purdy
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Kate Tilling
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| | - Yoav Ben-Shlomo
- The National Institute for Health Research and Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 58 Whiteladies Rd, Bristol, BS8 2PL, UK
| |
Collapse
|
12
|
Petersen J, Kandt J, Longley P. Ethnic disparities in preventable hospitalisation in England: an analysis of 916 375 emergency admissions. J Epidemiol Community Health 2021; 76:85-91. [PMID: 34168054 PMCID: PMC8666822 DOI: 10.1136/jech-2020-216005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To study ethnic inequalities in ambulatory care sensitive conditions (ACSC) in England. DESIGN Observational study of inpatient hospital admission database enhanced with ethnicity coding of patient surnames. The primary diagnosis of the first episode in spells with emergency admission were coded with definitions for acute ACSC, chronic ACSC and vaccine-preventable diseases. SETTING National Health Service England. PARTICIPANTS 916 375 ACSC emergency admissions in 7 39 618 patients were identified between April 2011 and March 2012. MAIN OUTCOME MEASURES ORs of ACSC for each ethnic group relative to the White British majority group adjusted for age, sex and area deprivation. RESULTS Acute ACSC admission risk adjusted for age and sex was particularly high among Other (OR 1.73; 95% CI 1.69 to 1.77) and Pakistani (1.51; 95% CI 1.48 to 1.54) compared with White British patients. For chronic ACSC, high risk was found among Other (2.02; 95% CI 1.97 to 2.08), Pakistani (2.07; 95% CI 2.02 to 2.12) and Bangladeshi (1.36; 95% CI 1.30 to 1.42). For vaccine-preventable diseases, other (2.42; 95% CI 2.31 to 2.54), Pakistani (1.94; 95% CI 1.85 to 2.04), Bangladeshi (1.48; 95% CI 1.36 to 1.62), Black African (1.45; 95% CI 1.36 to 1.54) and white other (1.38; 95% CI 1.33 to 1.43) groups. Elevated risk was only partly explained in analyses also adjusting for area deprivation. CONCLUSIONS ACSC admission was especially high among individuals of Bangladeshi, Pakistani, Black African, white other or other background with up to twofold differences compared with the white British group. This suggests that these ethnic groups are not receiving optimal primary care.
Collapse
Affiliation(s)
| | - Jens Kandt
- The Bartlett Centre for Advanced Spatial Analysis (CASA), University College London, London, UK
| | | |
Collapse
|
13
|
Impact of Integrated Care on the Rate of Hospitalization for Ambulatory Care Sensitive Conditions among Older Adults in Stockholm County: An Interrupted Time Series Analysis. Int J Integr Care 2021; 21:22. [PMID: 34163311 PMCID: PMC8195125 DOI: 10.5334/ijic.5505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Reducing avoidable hospital admissions is often viewed as a possible positive consequence of introducing integrated care (IC). The aim of this study was to investigate the impact of implementing IC in Norrtälje on the rate of admissions for ambulatory care sensitive conditions (ACSC). Method: Using interrupted time series analyses we investigated the effect of implementing IC in Norrtälje municipality in the northern part of Stockholm county, Sweden. The time period included 48 time points, from year 2000 to year 2011 with measurements before and after introducing IC in Norrtälje in 2006. In order to control for other extraneous events that could affect the outcome measure, but not related to the introduction of IC, we included a control population from Stockholm municipality. Results: After introducing IC in Norrtälje the rate of admissions for ACSC decreased. This decrease was greater in Norrtälje than in the matched control population, however the difference between the two areas was not statistically significant (p = 0.08). Conclusion: Introducing IC in Norrtälje may have had positive impact on admissions for ACSC for older people living in Norrtälje; however, the interpretation of the impact of IC on admissions for ACSC is complicated by intervening policy changes in health and social care during the study period.
Collapse
|
14
|
Loureiro da Silva C, Rocha JV, Santana R. Economic and financial crisis based on Troika's intervention and potentially avoidable hospitalizations: an ecological study in Portugal. BMC Health Serv Res 2021; 21:506. [PMID: 34039326 PMCID: PMC8152149 DOI: 10.1186/s12913-021-06475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 05/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalisations for Ambulatory Care Sensitive Conditions (ACSC) cause harm to users and to health systems, as these events are potentially avoidable. In 2009, Portugal was hit by an economic and financial crisis and in 2011 it resorted to foreign assistance ("Memorandum of Understanding" (2011-2014)). The aim of this study was to analyse the association between the Troika intervention and hospitalisations for ACSC. METHODS We analysed inpatient data of all public NHS hospitals of mainland Portugal from 2007 to 2016, and identified hospitalisations for ACSC (pneumonia, chronic obstructive pulmonary disease, hearth failure, hypertensive heart disease, urinary tract infections, diabetes), according to the AHRQ methodology. Rates of hospitalisations for ACSC, the rate of enrollment in the employment center and average monthly earnings were compared among the pre-crisis, crisis and post-crisis periods to see if there were differences. A Spearman's correlation between socioeconomic variables and hospitalisations was performed. RESULTS Among 8,160,762 admissions, 892,759 (10.94%) were classified as ACSC hospitalizations, for which 40% corresponded to pneumonia. The rates of total hospitalisations and hospitalisations for ACSC increased between 2007 and 2016, with the central and northern regions of the country presenting the highest rates. No correlations between socioeconomic variables and hospitalisation rates were found. CONCLUSIONS During the period of economic and financial crisis based on Troika's intervention, there was an increase in potentially preventable hospitalisations in Portugal, with disparities between the municipalities. The high use of resources from ACSC hospitalisations and the consequences of the measures taken during the crisis are factors that health management must take into account.
Collapse
Affiliation(s)
- Cristina Loureiro da Silva
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
| | - João Victor Rocha
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560 Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
15
|
Campelo Barroso Carneiro VC, Ribeiro de Oliveira PDT, Rassy Carneiro S, Cardoso Maciel M, da Silva Pedroso J. Evidence of the effect of primary care expansion on hospitalizations: Panel analysis of 143 municipalities in the Brazilian Amazon. PLoS One 2021; 16:e0248823. [PMID: 33831030 PMCID: PMC8031449 DOI: 10.1371/journal.pone.0248823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/06/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The Family Health Strategy (FHS) became consolidated as a primary care model and gatekeeper for the Unified Health System (Sistema Único de Saúde, SUS) in the Brazil and it is considered one of the largest primary health care programmes in the world. Its rapid expansion allowed the SUS to meet the changing health care needs of the population remote localities of Brazilian municipalities. METHODS In the present study, exploratory data analysis was performed using modelling to provide a general overview of the study and to delineate possible structural characteristics of the cross-sectional time-series data. Panel regression methods were used to assess the association between FHS coverage and ambulatory care-sensitive hospitalizations (ACSH rates) in the municipalities of Pará, in the Brazilian Amazon, from 2008 to 2017. RESULTS The results showed strong evidence for the association between FHS coverage and ACSH rates, including reductions of 22% in preventable hospitalizations and 15% in hospital expenses that were directly linked to the 40% increase in FHS population coverage during the evaluated period. This expansion of primary care has mainly benefitted areas that are difficult to access and populations that were previously deprived of health care in the vast Amazon territory. CONCLUSIONS The findings of this study show that the increase of the expansion of primary care reduces the preventable hospitalization and the hospital expenses. This reinforces the need for public protection of the health of populations at risk and the positive impacts of primary care in the Brazilian Amazon.
Collapse
Affiliation(s)
| | | | - Saul Rassy Carneiro
- João de Barros Barreto University Hospital, Federal University of Pará, Belém, Pará, Brazil
| | | | | |
Collapse
|
16
|
Satokangas M, Arffman M, Antikainen H, Leyland AH, Keskimäki I. Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland: A Register-based Study. Med Care 2021; 59:123-130. [PMID: 33201086 PMCID: PMC7899221 DOI: 10.1097/mlr.0000000000001454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Measuring primary health care (PHC) performance through hospitalizations for ambulatory care sensitive conditions (ACSCs) remains controversial-recent cross-sectional research claims that its geographic variation associates more with individual socioeconomic position (SEP) and health status than PHC supply. OBJECTIVES To clarify the usage of ACSCs as a PHC performance indicator by quantifying how disease burden, both PHC and hospital supply and spatial access contribute over time to geographic variation in Finland when individual SEP and comorbidities were adjusted for. METHODS The Finnish Care Register for Health Care provided hospitalizations for ACSCs (divided further into subgroups of acute, chronic, and vaccine-preventable causes) in 2011-2017. With 3-level nested multilevel Poisson models-individuals, PHC authorities, and hospital authorities-we estimated the proportion of the variance in ACSCs explained by selected factors at 3 time periods. RESULTS In age-adjusted and sex-adjusted analysis of total ACSCs the variances between hospital authorities was nearly twice that between PHC authorities. Individual SEP and comorbidities explained 19%-30% of the variance between PHC authorities and 25%-36% between hospital authorities; and area-level disease burden and arrangement and usage of hospital care a further 14%-16% and 32%-33%-evening out the unexplained variances between PHC and hospital authorities. CONCLUSIONS Alongside individual factors, areas' disease burden and factors related to hospital care explained the excess variances in ACSCs captured by hospital authorities. Our consistent findings over time suggest that the local strain on health care and the regional arrangement of hospital services affect ACSCs-necessitating caution when comparing areas' PHC performance through ACSCs.
Collapse
Affiliation(s)
- Markku Satokangas
- Department of General Practice and Primary Health Care, Network of Academic Health Centres, University of Helsinki
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
| | - Martti Arffman
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
| | | | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland
| | - Ilmo Keskimäki
- Service System Research Unit, Finnish Institute for Health and Welfare, Helsinki
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| |
Collapse
|
17
|
Castro DMD, Oliveira VBD, Andrade ACDS, Cherchiglia ML, Santos ADFD. [The impact of primary healthcare and the reduction of primary health care-sensitive hospital admissions]. CAD SAUDE PUBLICA 2020; 36:e00209819. [PMID: 33237208 DOI: 10.1590/0102-311x00209819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/27/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to analyze the association between quality of primary healthcare (PHC) in Brazilian municipalities (counties) and the number of hospitalizations due to primary healthcare-sensitive conditions. This was an ecological study with analysis of nationwide secondary data. The quality of the number of hospitalizations due to primary healthcare-sensitive conditions was based on assessment of the National Program for Improvement of Access and Quality of Basic Care (PMAQ-AB). The analysis used a hierarchical explanatory model, with the number of the number of hospitalizations due to primary healthcare-sensitive conditions hospitalizations in the year 2014 as the dependent variable and sociodemographic and health system data as the independent variables. The measure of association between the number of hospitalizations and quality of PHC was calculated with negative binomial regression with robust variance and the total population as offset, with significance set at 20% in the univariate analysis and 5% in the multivariate analysis. The mean number of hospitalizations due to primary healthcare-sensitive conditions admissions during the target period was 359.97 hospitalizations per municipality. The quality of PHC showed a negative association with the number of hospitalizations due to primary healthcare-sensitive conditions admissions. Municipalities with lower quality of PHC (quartile 1) showed 21.2% more number of hospitalizations due to primary healthcare-sensitive conditions admissions than municipalities with higher quality (95%CI: 1.09-1.34). The results showed that quality of PHC in Brazil reduced hospitalizations due to primary healthcare-sensitive conditions, even in contexts of social vulnerability.
Collapse
|
18
|
Shinotsuka M, Matsumura S, Okada T. Emergency admissions of ambulatory care sensitive conditions at a Japanese local hospital: An observational study. J Gen Fam Med 2020; 21:235-241. [PMID: 33304717 PMCID: PMC7689229 DOI: 10.1002/jgf2.352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 05/16/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Emergency admissions of ambulatory care sensitive conditions (ACSCs) are a key marker of quality of primary care and are used nationwide in some countries including the UK and Australia. There are still little data on ACSCs available in Japan. This study aimed to provide the descriptive data of the current state of ACSCs at a local hospital in Japan. METHODS This is an observational study of retrospective chart review. The study setting is Funabashi Futawa Hospital (FFH), an acute care private hospital in Funabashi City, Japan. We analyzed the shares of admissions of ACSCs out of all admissions at FFH from April 2014 to March 2015. RESULTS 5380 charts were reviewed. Emergency admissions were 3275 cases (61%) of all admissions. Emergency admissions for ACSCs accounted for 946 cases (28.9%) of all emergency admissions. Chronic ACSC is the most common subcategory. Urinary tract infection accounted most for admissions of acute ACSCs (138 cases, 4.2% of all emergency admissions). Asthma accounted most for admissions of chronic ACSCs (139 cases, 4.2%). Pneumonia accounted most for admissions of vaccine-preventable ACSCs (99 cases, 3.0%). CONCLUSIONS This is one of the first reports describing ACSCs in Japan. Most common reasons for ACSCs were similar to the previous data from the UK, except COPD ranked lower and asthma ranked higher, respectively. Comparison among different facilities (horizontal) and over time in the same institution (longitudinal), as well as analyzing relationships between other markers of primary care quality and ACSCs, will be necessary in the future.
Collapse
Affiliation(s)
- Manami Shinotsuka
- Funabashi Futawa HospitalFunabashi CityJapan
- Ichikawa Civil ClinicIchikawa CityJapan
| | - Shin Matsumura
- Tessyokai Kameda Family Clinic TateyamaTateyama CityJapan
- Matsumura Family ClinicKamakura CityJapan
| | - Tadao Okada
- Tessyokai Kameda Family Clinic TateyamaTateyama CityJapan
| |
Collapse
|
19
|
Rose TC, Adams NL, Whitehead M, Wickham S, O'Brien SJ, Hawker J, Taylor-Robinson DC, Violato M, Barr B. Neighbourhood unemployment and other socio-demographic predictors of emergency hospitalisation for infectious intestinal disease in England: A longitudinal ecological study. J Infect 2020; 81:736-742. [PMID: 32888980 PMCID: PMC7649336 DOI: 10.1016/j.jinf.2020.08.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/22/2020] [Accepted: 08/30/2020] [Indexed: 11/29/2022]
Abstract
We examined trends in infectious intestinal disease (IID) hospitalisations in England. Overall IID admission rates for children and older adults declined between 2012 & 2017. Increasing unemployment was associated with increasing IID admission rates. Healthcare access, underlying morbidity and ethnicity were also associated with IID rates. Policies should address inequalities in emergency IID hospitalisations.
Background Previous studies have observed that infectious intestinal disease (IID) related hospital admissions are higher in more deprived neighbourhoods. These studies have mainly focused on paediatric populations and are cross-sectional in nature. This study examines recent trends in emergency IID admission rates, and uses longitudinal methods to investigate the effects of unemployment (as a time varying measure of neighbourhood deprivation) and other socio-demographic characteristics on IID admissions for adults and children in England. Methods A longitudinal ecological analysis was performed using Hospital Episode Statistics on emergency hospitalisations for IID, collected over the time period 2012–17 across England. Analysis was conducted at the neighbourhood (Lower-layer Super Output Area) level for three age groups (0–14; 15–64; 65+ years). Mixed-effect Poisson regression models were used to assess the relationship between trends in neighbourhood unemployment and emergency IID admission rates, whilst controlling for measures of primary and secondary care access, underlying morbidity and the ethnic composition of each neighbourhood. Results From 2012–17, declining trends in emergency IID admission rates were observed for children and older adults overall, while rates increased for some sub-groups in the population. Each 1 percentage point increase in unemployment was associated with a 6.3, 2.4 and 4% increase in the rate of IID admissions per year for children [IRR=1.06, 95%CI 1.06–1.07], adults [IRR=1.02, 95%CI 1.02–1.03] and older adults [IRR=1.04, 95%CI 1.036–1.043], respectively. Increases in poor primary care access, the percentage of people from a Pakistani ethnic background, and the prevalence of long-term health problems, in a neighbourhood, were also associated with increases in IID admission rates. Conclusions Increasing trends in neighbourhood deprivation, as measured by unemployment, were associated with increases in emergency IID admission rates for children and adults in England, despite controlling for measures of healthcare access, underlying morbidity and ethnicity. Research is needed to improve understanding of the mechanisms that explain these inequalities, so that effective policies can be developed to reduce the higher emergency IID admission rates experienced by more disadvantaged communities.
Collapse
Affiliation(s)
- Tanith C Rose
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK.
| | - Natalie L Adams
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Sarah J O'Brien
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Jeremy Hawker
- National Infection Service, Public Health England, Birmingham, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| | - Mara Violato
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Benjamin Barr
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, UK
| |
Collapse
|
20
|
Wallar LE, Rosella LC. Individual and neighbourhood socioeconomic status increase risk of avoidable hospitalizations among Canadian adults: A retrospective cohort study of linked population health data. Int J Popul Data Sci 2020; 5:1351. [PMID: 32935060 PMCID: PMC7477780 DOI: 10.23889/ijpds.v5i1.1351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Avoidable hospitalizations refer to acute care use for conditions that should normally be managed in primary care settings. Lower socioeconomic status that is often measured using area-based indicators (e.g. median household income) has been shown to increase risk of avoidable hospitalizations. However, both area- and individual-level socioeconomic status can contribute to hospitalization risk, but previous data limitations have prevented separate analyses. Further, the joint effect of individual and neighbourhood socioeconomic status has not been established in the Canadian population. To address this, this study links individual-level household income and neighbourhood-level material deprivation data within a population-based Canadian cohort. OBJECTIVES To determine the individual and joint effect of individual-level household income and neighbourhood-level material deprivation on risk of hospitalization for a set of chronic ambulatory care sensitive conditions using linked health survey, hospital discharge, and census-derived data. METHODS A pooled cohort was created by linking sociodemographic and health information from eight cycles of the Canadian Community Health Survey (2000/2001 - 2010) to hospital discharge records and Canadian Marginalization Indices (2001, 2006) (N = 354,595). The primary outcome variable was risk of index hospitalization with a primary diagnosis of angina, asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, epilepsy, or hypertension. The primary exposure variable was joint individual-level national household income quintile and neighbourhood-level material deprivation quintile. Relative risk (RR) was estimated by constructing modified Poisson regression models with robust error variance. RESULTS In fully adjusted models with income and deprivation considered separately, individuals in the lowest household income quintile and highest material deprivation quintile were at increased risk of hospitalization (Income RR: 1.82 (95% CI 1.56-2.13) Deprivation RR: 1.67 (1.44-1.95)). When income and deprivation were jointly considered, those with low individual income living in high deprivation neighbourhoods were at greatest risk of hospitalization (RR 1.83 (95% CI 1.63 - 2.05)). CONCLUSION Both individual income and neighbourhood deprivation separately and jointly increase risk of avoidable hospitalizations. Additional research is needed to understand their mechanisms of action. However, both levels should be considered when designing effective policies and interventions to reduce avoidable hospitalizations.
Collapse
Affiliation(s)
- LE Wallar
- Dalla Lana School of Public Health, 155 College St Room 500, University of Toronto, Toronto, ON M5T 3M7
| | - LC Rosella
- Dalla Lana School of Public Health, 155 College St Room 500, University of Toronto, Toronto, ON M5T 3M7
| |
Collapse
|
21
|
Sarmento J, Rocha JVM, Santana R. Defining ambulatory care sensitive conditions for adults in Portugal. BMC Health Serv Res 2020; 20:754. [PMID: 32799880 PMCID: PMC7429814 DOI: 10.1186/s12913-020-05620-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ambulatory Care Sensitive Conditions (ACSCs) are health conditions for which adequate management, treatment and interventions delivered in the ambulatory care setting could potentially prevent hospitalization. Which conditions are sensitive to ambulatory care varies according to the scope of health care services and the context in which the indicator is used. The need for a country-specific validated list for Portugal has already been identified, but currently no national list exists. The objective of this study was to develop a list of Ambulatory Care Sensitive Conditions for Portugal. METHODS A modified web-based Delphi panel approach was designed, in order to determine which conditions can be considered ACSCs in the Portuguese adult population. The selected experts were general practitioners and internal medicine physicians identified by the most relevant Portuguese scientific societies. Experts were presented with previously identified ACSC and asked to select which could be accepted in the Portuguese context. They were also asked to identify other conditions they considered relevant. We estimated the number and cost of ACSC hospitalizations in 2017 in Portugal according to the identified conditions. RESULTS After three rounds the experts agreed on 34 of the 45 initially proposed items. Fourteen new conditions were proposed and four achieved consensus, namely uterine cervical cancer, colorectal cancer, thromboembolic venous disease and voluntary termination of pregnancy. In 2017 133,427 hospitalizations were for ACSC (15.7% of all hospitalizations). This represents a rate of 1685 per 100,000 adults. The most frequent diagnosis were pneumonia, heart failure, chronic obstructive pulmonary disease/chronic bronchitis, urinary tract infection, colorectal cancer, hypertensive disease atrial fibrillation and complications of diabetes mellitus. CONCLUSIONS New ACSC were identified. It is expected that this list could be used henceforward by epidemiologic studies, health services research and for healthcare management purposes. ACSC lists should be updated frequently. Further research is necessary to increase the specificity of ACSC hospitalizations as an indicator of healthcare performance.
Collapse
Affiliation(s)
- João Sarmento
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal.
| | - João Victor Muniz Rocha
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- NOVA National School of Public Health, Public Health Research Center, Universidade NOVA de Lisboa, Av. Padre Cruz, 1600-560, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
22
|
Phillips T, Porter A, Sinclair J. Clinical Competencies for the Care of Hospitalized Patients with Alcohol Use Disorders. Alcohol Alcohol 2020; 55:395-400. [PMID: 32318727 PMCID: PMC7307320 DOI: 10.1093/alcalc/agaa024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/15/2020] [Accepted: 03/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The UK government aims to develop alcohol care teams (ACTs) that provide care for alcohol dependence in general hospital settings. Service descriptors have been identified to support the development of ACTs. The aim of this study was to use Delphi panel principles to identify the clinical competencies required to provide these elements of service. METHODS We formed an expert consensus panel of 24 senior clinical alcohol practitioners, leaders and experts by experience drawn from all regions of England. The study was divided into three distinct phases: (a) a review and synthesis of current literature in this area, (b) a face-to-face meeting of the expert panel and (c) subsequent iterations to refine the competencies until consensus was reached. RESULTS Our initial search strategy resulted in 555 competency statements being extracted from a range of national clinical professional and occupational standards and other sources. The research team refined these statements to 98 competencies in advance of the expert meeting. The panel identified 14 additional statements and reduced the number of competencies to 78. Subsequent iterations finalized 72 competencies across the 8 service descriptors. CONCLUSIONS Drawing on the existing published resources and clinical experience, the expert panel has provided consensus on the core clinical competencies required for alcohol care teams in caring for hospitalized patients with alcohol use disorders. Whilst it is acknowledged that the range of current provision is variable, these competencies provide a template for clinical practice and the development of multidisciplinary ACTs.
Collapse
Affiliation(s)
- Thomas Phillips
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Amy Porter
- Institute for Clinical and Applied Health Research, University of Hull, Hull, UK
| | - Julia Sinclair
- Faculty of Medicine, University of Southampton, Southampton, UK
| |
Collapse
|
23
|
Leão HM, Caldeira AP. Accessibility and care pathways for children admitted to hospital for ambulatory care sensitive conditions. CIENCIA & SAUDE COLETIVA 2020; 26:3301-3310. [PMID: 34378717 DOI: 10.1590/1413-81232021268.08882020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/01/2020] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to analyze health service accessibility and the care pathways of children admitted to hospital for ambulatory care sensitive conditions (ACSCs). A cross-sectional study was conducted of a random sample of children hospitalized over a period of one year in a town in the north of Minas Gerais, Brazil. The Primary Care Assessment Tool Child Edition, adapted and validated for use in Brazil (PCAT-CE), was used to assess accessibility and interviews were conducted with the children's carers to determine the pathway taken to hospitalization. Of the 376 pediatric hospitalizations assessed, 109 (28.9%) were classified as ACSC admissions. Health service accessibility and utilization scores were low for both the ACSC and non-ACSC groups. No statistically significant differences (p<0.05) were found between the two groups. The care pathways reveal that most families visited hospitals as the first service and that visits to other health services were frequent. Well over half (63.3%) of the families of children admitted for ACSCs did not seek primary health services at any time. Accessibility was poor among the study group, regardless of the reason that led to hospitalization. The care pathways reveal an irregular pattern of service utilization for children admitted for ACSCs, suggesting a fragile health care network.
Collapse
Affiliation(s)
- Harley Medawar Leão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Campus Universitário Professor Darcy Ribeiro s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| | - Antônio Prates Caldeira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Montes Claros. Campus Universitário Professor Darcy Ribeiro s/n, Vila Mauriceia. 39401-089 Montes Claros MG Brasil.
| |
Collapse
|
24
|
Wilk P, Ali S, Anderson KK, Clark AF, Cooke M, Frisbee SJ, Gilliland J, Haan M, Harris S, Kiarasi S, Maltby A, Norozi K, Petrella R, Sarma S, Singh SS, Stranges S, Thind A. Geographic variation in preventable hospitalisations across Canada: a cross-sectional study. BMJ Open 2020; 10:e037195. [PMID: 32414831 PMCID: PMC7232620 DOI: 10.1136/bmjopen-2020-037195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this study is to examine the magnitude and pattern of small-area geographic variation in rates of preventable hospitalisations for ambulatory care-sensitive conditions (ACSC) across Canada (excluding Québec). DESIGN AND SETTING A cross-sectional study conducted in Canada (excluding Québec) using data from the 2006 Canadian Census Health and Environment Cohort (CanCHEC) linked prospectively to hospitalisation records from the Discharge Abstract Database (DAD) for the three fiscal years: 2006-2007, 2007-2008 and 2008-2009. PRIMARY OUTCOME MEASURE Preventable hospitalisations (ACSC). PARTICIPANTS The 2006 CanCHEC represents a population of 22 562 120 individuals in Canada (excluding Québec). Of this number, 2 940 150 (13.03%) individuals were estimated to be hospitalised at least once during the 2006-2009 fiscal years. METHODS Age-standardised annualised ACSC hospitalisation rates per 100 000 population were computed for each of the 190 Census Divisions. To assess the magnitude of Census Division-level geographic variation in rates of preventable hospitalisations, the global Moran's I statistic was computed. 'Hot spot' analysis was used to identify the pattern of geographic variation. RESULTS Of all the hospitalisation events reported in Canada during the 2006-2009 fiscal years, 337 995 (7.10%) events were ACSC-related hospitalisations. The Moran's I statistic (Moran's I=0.355) suggests non-randomness in the spatial distribution of preventable hospitalisations. The findings from the 'hot spot' analysis indicate a cluster of Census Divisions located in predominantly rural and remote parts of Ontario, Manitoba and Saskatchewan and in eastern and northern parts of Nunavut with significantly higher than average rates of preventable hospitalisation. CONCLUSION The knowledge generated on the small-area geographic variation in preventable hospitalisations can inform regional, provincial and national decision makers on planning, allocation of resources and monitoring performance of health service providers.
Collapse
Affiliation(s)
- Piotr Wilk
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Andrew F Clark
- Department of Geography, Western University, London, Ontario, Canada
| | - Martin Cooke
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Stephanie J Frisbee
- Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
| | - Jason Gilliland
- Department of Geography, Western University, London, Ontario, Canada
| | - Michael Haan
- Department of Sociology, Western University, London, Ontario, Canada
| | - Stewart Harris
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Soushyant Kiarasi
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Alana Maltby
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kambiz Norozi
- Department of Paediatrics, Western University, London, Ontario, Canada
| | - Robert Petrella
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Sisira Sarma
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sarah S Singh
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| |
Collapse
|
25
|
Wallar LE, Rosella LC. Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study. PLoS One 2020; 15:e0229465. [PMID: 32182242 PMCID: PMC7077875 DOI: 10.1371/journal.pone.0229465] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/06/2020] [Indexed: 12/14/2022] Open
Abstract
Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000–2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17–3.23); Female HR 3.41 (2.81–4.13)) and being underweight (Male HR 1.98 (1.14–3.43); Female HR 2.78 (1.61–4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69–0.98); (Female HR 0.69 (0.57–0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.
Collapse
Affiliation(s)
- Lauren E. Wallar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Laura C. Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|
26
|
Rocha JVM, Nunes C, Santana R. Avoidable hospitalizations in Brazil and Portugal: Identifying and comparing critical areas through spatial analysis. PLoS One 2019; 14:e0219262. [PMID: 31299045 PMCID: PMC6625697 DOI: 10.1371/journal.pone.0219262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions have been used to assess the performance of primary health care. Few studies have compared geographic variation in rates of avoidable hospitalizations and characteristics of high-risk areas within and between countries. The aim of this study was to identify and compare critical areas of avoidable hospitalizations in Brazil and Portugal, because these countries have reformed their primary health care systems in recent years and have similar organizational characteristics. METHODS An ecological study on hospitalizations for ambulatory care sensitive conditions produced in Brazil and Portugal in 2015 was used. Geographic variation of rates were analyzed and compared at the municipal level. A spatial scan statistic was employed to identify clusters with higher risk of hospitalizations for acute and chronic conditions in each country separately. Socioeconomic and primary health care characteristics of critical areas were compared to non-critical areas. RESULTS There were high variations in rates of avoidable hospitalizations within and between Brazil and Portugal, with higher variations found in Brazil. A more evident pattern of rates was found in Portugal. Rates and cluster distribution of acute and chronic conditions had significant agreement for both countries. The differences in primary health care and socioeconomic characteristics between areas identified as high risk clusters and non-clusters varied between category of conditions and between countries. CONCLUSION Brazil and Portugal presented expressive regional differences with respect to rates of avoidable hospitalizations, indicating that there is room to improve by reducing such events in both countries. Different areas presented distinct interactions between primary health care, socioeconomic characteristics, and avoidable hospitalizations. Results indicate that the primary health care reforms, with similar organizational characteristics in different contexts, did not produce similar results either between or within countries. Possible actions to reduce these events should be defined at a local level.
Collapse
Affiliation(s)
- João Victor Muniz Rocha
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| |
Collapse
|
27
|
Kim J, Kang HY, Lee KS, Min S, Shin E. A Spatial Analysis of Preventable Hospitalization for Ambulatory Care Sensitive Conditions and Regional Characteristics in South Korea. Asia Pac J Public Health 2019; 31:422-432. [DOI: 10.1177/1010539519858452] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hospitalization rates for ambulatory care sensitive conditions (ACSCs) can indicate the accessibility of a community’s primary care. We examined regional variation in ACSC hospitalization rates and identified associated factors. ACSC hospitalization rates in the 232 districts in 2013 ranged from 4.08 to 101.53 per 1000 adults. Spatial analysis showed that none of the 24 highest rate districts were located near Seoul, whereas 80% of the 45 lowest rate districts were, suggesting health care inequality between people living near Seoul and in other areas. Regression analysis showed significantly higher ACSC hospitalization rates in districts with higher elderly (β = 0.94) and low-income populations (β = 2.25), more remote areas (β = 0.29), and more hospital beds (β = 0.03). The number of primary care clinics was negatively associated with ACSC hospitalization (β = −1.37). For these variables, geographically weighted regression analysis provided local regression coefficients, useful for developing region-specific strategies to reduce ACSC hospitalization.
Collapse
Affiliation(s)
| | | | | | | | - Euichul Shin
- The Catholic University of Korea, Seoul, South Korea
| |
Collapse
|
28
|
Friebel R, Fisher R, Deeny SR, Gardner T, Molloy A, Steventon A. The implications of high bed occupancy rates on readmission rates in England: A longitudinal study. Health Policy 2019; 123:765-772. [PMID: 31262535 DOI: 10.1016/j.healthpol.2019.06.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/24/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
Hospital bed occupancy rates in the English National Health Service have risen to levels considered clinically unsafe. This study assesses the association of increased bed occupancy with changes in the percentage of overnight patients discharged from hospital on a given day, and their subsequent 30-day readmission rate. Longitudinal panel data methods are used to analyse secondary care records (n = 4,193,590) for 136 non-specialist Trusts between April 2014 and February 2016. The average bed occupancy rate across the study period was 90.4%. A 1% increase in bed occupancy was associated with a 0.49% rise in the discharge rate, and a 0.011% increase in the 30-day readmission rate for discharged patients. These associations became more pronounced once bed occupancy exceeded 95%. When bed occupancy rates were high, hospitals discharged a greater proportion of their patients. Those were mostly younger and less clinically complex, suggesting that hospitals are successfully prioritising early discharge amongst least vulnerable patients. However, while increased bed occupancy was not associated with a substantial increase in overall 30-day readmission rates, the relationship was more pronounced in older and sicker patients, indicating possible links with short-fallings in discharge processes.
Collapse
Affiliation(s)
- Rocco Friebel
- Department of Health Policy, The London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom; Center for Global Development, 1 Great College Street, London, SW1P 3SE, United Kingdom.
| | - Rebecca Fisher
- The Health Foundation, 90 Long Acre, London, WC2E 9RA, United Kingdom
| | - Sarah R Deeny
- The Health Foundation, 90 Long Acre, London, WC2E 9RA, United Kingdom
| | - Tim Gardner
- The Health Foundation, 90 Long Acre, London, WC2E 9RA, United Kingdom
| | - Aoife Molloy
- School of Public Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom; NHS England and NHS Improvement, Skipton House, 80 London Road, London, SE1 6LH, United Kingdom
| | - Adam Steventon
- The Health Foundation, 90 Long Acre, London, WC2E 9RA, United Kingdom
| |
Collapse
|
29
|
Lockhart E, Hawker GA, Ivers NM, O'Brien T, Mukerji G, Pariser P, Stanaitis I, Pus L, Baker GR. Engaging primary care physicians in care coordination for patients with complex medical conditions. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e155-e162. [PMID: 30979773 PMCID: PMC6467654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the dynamics of primary care physicians' (PCPs') engagement with the Seamless Care Optimizing the Patient Experience (SCOPE) project. DESIGN Qualitative study using semistructured interviews. SETTING Solo and small group primary care practices in urban Toronto, Ont. PARTICIPANTS A total of 22 of the 29 SCOPE PCPs (75.8%) were interviewed 14 to 19 months after the initiation of SCOPE. METHODS Qualitative semistructured interviews were conducted to examine influencing factors associated with PCPs' engagement in SCOPE. Transcripts were analyzed using a grounded theory-informed approach and key themes were identified. MAIN FINDINGS The SCOPE project provided practical mechanisms through which PCPs could access information and connect with resources. Contextual and historical factors including strained relationships between hospital specialists and community PCPs and PCPs' feelings of responsibility, isolation, disconnection, and burnout influenced readiness to engage. Provision of clinically useful supports in a trusting, collaborative manner encouraged PCPs' engagement in newer, more collaborative ways of working. CONCLUSION The SCOPE project provided an opportunity for PCPs to build meaningful relationships, reconnect to the broader health care system, and redefine their roles. For many PCPs, reestablishing connections reaffirmed their role in the system and enabled a more collaborative care model. Strategies for connecting community-based PCPs to the broader system need to consider contextual factors and the effects of new linkages and coordination on the identities and relationships of PCPs.
Collapse
Affiliation(s)
- Elizabeth Lockhart
- Graduate student at the Institute of Health Policy, Management and Evaluation at the University of Toronto in Ontario.
| | - Gillian A Hawker
- Professor in the Institute of Health Policy, Management and Evaluation and the Department of Medicine at the University of Toronto, and Senior Scientist at Women's College Research Institute
| | - Noah M Ivers
- Assistant Professor in the Institute of Health Policy, Management and Evaluation and the Department of Family and Community Medicine at the University of Toronto, and a family physician at Women's College Hospital
| | - Tara O'Brien
- Medical Director of the Acute Ambulatory Care Unit at Women's College Hospital and the Division of General Internal Medicine at the University of Toronto
| | - Geetha Mukerji
- Assistant Professor in the Institute of Health Policy, Management and Evaluation and the Division of Endocrinology and Metabolism at the University of Toronto, and a staff endocrinologist at Women's College Hospital
| | - Pauline Pariser
- Associate Professor in the Department of Family and Community Medicine at the University of Toronto and Associate Medical Director at University Health Network
| | - Ian Stanaitis
- Research Project Coordinator at Women's College Hospital
| | - Laura Pus
- Director, Women's Virtual at Women's College Hospital
| | - G Ross Baker
- Professor in the Institute of Health Policy, Management and Evaluation at the University of Toronto
| |
Collapse
|
30
|
van der Pol M, Olajide D, Dusheiko M, Elliott R, Guthrie B, Jorm L, Leyland AH. The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis. BMC FAMILY PRACTICE 2019; 20:32. [PMID: 30795737 PMCID: PMC6385424 DOI: 10.1186/s12875-019-0921-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time. METHODS Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated. RESULTS We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital. CONCLUSIONS The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.
Collapse
Affiliation(s)
- Marjon van der Pol
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Damilola Olajide
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | - Robert Elliott
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, UK
| | | | | | | |
Collapse
|
31
|
Jørgensen TSH, Siersma V, Lund R, Nilsson CJ. Mobility limitation as determinant of primary care use and ambulatory care sensitive conditions. Eur Geriatr Med 2019; 10:53-60. [PMID: 32720287 DOI: 10.1007/s41999-018-0149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/28/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE First, to investigate associations between mobility limitations and use of general practitioners and hospitalizations of acute care sensitive conditions, respectively. Second, to investigate whether these associations vary by socio-demographic factors. METHODS The study included 3574 females and males aged 75 or 80 years from the Danish Intervention Study on Preventive Home Visits. Fixed-effects logistic and poisson regression models were applied to study the relationship between mobility limitations (measured two-four times) and general practitioner consultations and hospitalizations with acute care sensitive conditions each subsequent year, respectively. RESULTS Each additional mobility limitation was associated with 15% higher odds of general practitioner home consultation (Odds ratio 1.15, 95% CI 1.07;1.23) and 4% increased incidence rate of general practitioner consultations among those with ≥ 1 consultation (Incidence rate ratio 1.04, 95% CI 1.03;1.04). There were no associations between mobility limitations and whether older adults had at least one general practitioner consultation nor acute care sensitive condition hospitalization. Test of interactions (p < 0.03) showed that more mobility limitations were associated with greater incidence rate of general practitioner consultations among males compared to females, married compared to unmarried, and older adults with high compared to low financial assets. CONCLUSIONS Older adults with more mobility limitations had more often a general practitioner home consultation. Mobility limitations were not associated with whether older adults had at least one general practitioner consultation, but increased mobility limitations were associated with higher contact rate among those who had ≥ 1 consultation, especially among males and older adults who were married or had high financial assets.
Collapse
Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen, Denmark.
- Center for Healthy Aging, University of Copenhagen, 1123, Copenhagen K, Denmark.
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, 1123, Copenhagen K, Denmark
- Danish Aging Research Center, University of Southern Denmark, University of Aarhus and University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Juul Nilsson
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, 1123, Copenhagen K, Denmark
| |
Collapse
|
32
|
Komwong D, Sriratanaban J. Associations between structures and resources of primary care at the district level and health outcomes: a case study of diabetes mellitus care in Thailand. Risk Manag Healthc Policy 2018; 11:199-208. [PMID: 30464660 PMCID: PMC6208489 DOI: 10.2147/rmhp.s177125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The structural factors of primary care potentially influence its performance and quality. This study investigated the association between structural factors, including available primary care resources and health outcomes, by using diabetes-related ambulatory care sensitive conditions hospitalizations under the Universal Coverage Scheme in Thailand. Methods A 2-year panel study used secondary data compiled at the district level. Administrative claim data from 838 districts during the 2014–2015 fiscal years from the National Health Security Office were used to analyze overall diabetes mellitus (DM) hospitalizations and its three subgroups: hospitalizations for uncontrolled diabetes, short-term complications, and long-term complications. Primary care structural data were obtained from the Ministry of Public Health. Generalized estimating equations were used to estimate the influence of structural factors on the age-standardized DM hospitalization ratio. Results A higher overall DM and uncontrolled diabetes hospitalization ratio was related to an increasing concentration of outpatient utilization (using the Herfindahl–Hirschman Index) (overall DM; beta [standard error, SE]=0.003 [0.001], 95% CI 0.000, 0.006) and decreasing physician density and bed supply (overall DM; beta [SE]=−1.350 [0.674], 95% CI −2.671, −0.028), beta [SE]=−0.023 [0.011], 95% CI −0.045, −0.001, respectively). Hospitalizations for short-term complications increased with a decrease in health care facility density, whereas hospitalizations for long-term complications increased as that density increased. Rurality was strongly associated with higher hospitalization ratios for all DM hospitalizations except short-term complications. Conclusions This study identified structural factors associated with health outcomes, many of which can be changed through reorganization at the district level.
Collapse
Affiliation(s)
- Daoroong Komwong
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, .,Sirindhorn College of Public Health, Praboromarajchanok Institute of Health Workforce Development, Chon Buri, Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, .,Thailand Research Center for Health Services System, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand,
| |
Collapse
|