PREVENTING EMERGENCY ADMISSIONS: PHYSICIAN REVIEW OF 132 RANDOMLY SELECTED PATIENTS WITH AMBULATORY CARE SENSITIVE CONDITIONS

ObjectivesTo examine the spatial and temporal patterns of English general practices’ emergency admissions for Ambulatory Care Sensitive Conditions (ACSCs).DesignObservational study of practice level annual hospital emergency admissions data for ACSCs for all English practices from 2004-2017.ParticipantsAll patients with an emergency admission to a National Health Service hospital in England who were registered with an English general practice.Main outcome measurePractice level age and gender indirectly standardised ratios (ISARs) for emergency admissions for ACSC.ResultsIn 2017, 41.8% of the total variation in ISARs across practices was between the 207 Clinical Commissioning Groups (CCGs) (the administrative unit for general practices) and 58.2% was across practices within CCGs. ACSC ISARs increased by 4.7% between 2004 and 2017, while those for conditions incentivised by the Quality and Outcomes Framework (QOF) fell by 20%. Practice ISARs are persistent: practices with high rates in 2004 also had high rates in 2017. Standardising by deprivation as well as age and gender reduced the coefficient of variation of practice ISARs in 2017 by 22%.ConclusionsThere is persistent spatial pattern of emergency admissions for ACSC across England both within and across CCGs. We illustrate the reduction in ACSCs emergency admissions across the study period for conditions incentivised by the QOF but find that this was not accompanied by a reduction in variation in these admissions across practices. The observed spatial pattern persists when admission rates are standardised by deprivation. The persistence of spatial clusters of high emergency admissions for ACSCs within and across CCG boundaries suggests that policies to reduce potentially unwarranted variation should be targeted at practice level.

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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 ◽

Ambulatory Care Sensitive Conditions ◽

Chronic Obstructive ◽

Main Diagnosis ◽

Increased Risk ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

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.

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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 ◽

Ambulatory Care Sensitive Conditions ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

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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 ◽

Ambulatory Care Sensitive Conditions ◽

Hospital System ◽

Bed Days ◽

Ambulatory Care Sensitive ◽

Sensitive Conditions

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.

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