Individual and Area-level Factors Contributing to the Geographic Variation in Ambulatory Care Sensitive Conditions in Finland

Hospital Services ◽

Over Time ◽

Abstract Background Geographic variation is common in ambulatory care sensitive conditions (ACSCs) - used as a proxy indicator for primary care quality. Its use is debated as it is more strongly associated with individual socioeconomic position (SEP) and health status than factors related to primary care. While most earlier studies have been cross-sectional, this study aims to observe if these associations change over time. Finland offers a good possibility for this due to its extensive registers and unexplained over time convergence of geographic variation in ACSC. Methods This observational study obtained ACSCs in 2011-2017 from the Finnish Hospital Discharge Register and divided them into subgroups of acute, chronic and vaccine-preventable causes. In these subgroups we analysed geographic variations with a three-level multilevel logistic regression model - individuals, health centre areas (HC) and hospital districts (HD) - and estimated the proportion of the variance at each level explained by individual SEP and comorbidities, as well as both primary care and hospital supply and spatial access at three time points. Results In the preliminary results of the baseline geographic variation in total ACSCs in 2011-2013 - the model with age and sex - the variance between HDs was nearly twice that between HCs. Individual SEP and comorbidities explained 46% of the variance between HDs and 29% between HCs; and area-level proportion of ACSC periods in primary care inpatient wards a further 12% and 5%. This evened out the unexplained variance between HDs and HCs. Conclusions Geographic variation in ACSCs was more pronounced in hospital districts than in the smaller health centre areas. The excess variance between HDs was explained by individual SEP and health status as well as by use of primary care inpatient wards. Our findings suggest that not only hospital bed supply, but also the national structure of hospital services affects ACSCs. This challenges international ACSC comparisons. Key messages Geographic variation in ACSCs concentrated in larger areas with differing population characteristics. The national structure of hospital services, such as use of primary care inpatient wards, affects ACSCs.

A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions

BMC Health Services Research ◽

10.1186/s12913-015-0964-3 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 34

Author(s):

John Busby ◽

Sarah Purdy ◽

William Hollingworth

Keyword(s):

Systematic Review ◽

Length Of Stay ◽

Hospital Admission ◽

Ambulatory Care ◽

Geographic Variation ◽

Admission Rates ◽

Rates of admission for ambulatory care sensitive conditions in France in 2009–2010: trends, geographic variation, costs, and an international comparison

The European Journal of Health Economics ◽

10.1007/s10198-015-0692-y ◽

2015 ◽

Vol 17 (4) ◽

pp. 453-470 ◽

Cited By ~ 29

Author(s):

William B. Weeks ◽

Bruno Ventelou ◽

Alain Paraponaris

Keyword(s):

Ambulatory Care ◽

Geographic Variation ◽

International Comparison ◽

Osteoarthritis and risk of hospitalization for ambulatory care sensitive conditions: A general population-based cohort study

Rheumatology ◽

10.1093/rheumatology/keab161 ◽

2021 ◽

Author(s):

Ali Kiadaliri ◽

Martin Englund

Keyword(s):

Ambulatory Care ◽

Hazard Model ◽

Population Based ◽

Incidence Rates ◽

Chronic Obstructive ◽

Main Diagnosis ◽

Increased Risk ◽

Abstract Objective To determine the association between osteoarthritis (OA) and risk of hospitalization for ambulatory care sensitive conditions (HACSCs). Methods We included all individuals aged 40–85 years who resided in Skåne, Sweden on 31st December 2005 with at least one healthcare consultation during 1998–2005 (n = 515 256). We identified those with a main diagnosis of OA between January 1, 1998 and December 31, 2016. People were followed from January 1st 2006 until an HACSC, death, relocation outside Skåne, or December 31st 2016 (whichever occurred first). OA status was treated as a time-varying covariate (those diagnosed before January 1, 2006 considered as exposed for whole study period). We assessed relative (hazard ratios (HRs) using Cox proportional hazard model) and absolute (hazard difference using additive hazard model) effects of OA on HACSCs adjusted for potential confounders. Results Crude incidence rates of HACSCs were 239 (95% CI 235, 242) and 151 (150, 152) per 10 000 person-years among OA and non-OA persons, respectively. The OA persons had an increased risk of HACSCs (HR [95% CI] 1.11 [1.09, 1.13]) and its subcategories of medical conditions except chronic obstructive pulmonary disease (HR [95% CI] 0.86 [0.81, 0.90]). There were 20 (95% CI 16, 24) more HACSCs per 10 000 person-years in OA compared with non-OA persons. While HRs for knee and hip OA were generally comparable, only knee OA was associated with increased risk of hospitalization for diabetes. Conclusion OA is associated with an increased risk of HACSCs, highlighting the urgent need to improve outpatient care for OA patients.

Ambulatory care-sensitive conditions: their potential uses and limitations

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-008820 ◽

2019 ◽

Vol 28 (6) ◽

pp. 429-433 ◽

Cited By ~ 12

Author(s):

Karen Hodgson ◽

Sarah R Deeny ◽

Adam Steventon

Keyword(s):

Ambulatory Care ◽

Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)

BMJ Open ◽

10.1136/bmjopen-2018-028744 ◽

2019 ◽

Vol 9 (11) ◽

pp. e028744 ◽

Cited By ~ 1

Author(s):

Geraldine McDarby ◽

Breda Smyth

Keyword(s):

Primary Care ◽

Ambulatory Care ◽

Integrated Care ◽

Hospital Admissions ◽

Acute Hospital ◽

Hospital System ◽

Bed Days ◽

BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.