scholarly journals Continuity of care, measurement and association with hospital admission and mortality: a registry-based longitudinal cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051958
Author(s):  
Øystein Hetlevik ◽  
Tor Helge Holmås ◽  
Karin Monstad
Keyword(s):  
Cohort Study ◽  
Ambulatory Care ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Index Score ◽  
Longitudinal Cohort Study ◽  
Ambulatory Care Sensitive Conditions ◽  
Longitudinal Cohort ◽  
Alternative Service ◽  
Ambulatory Care Sensitive

ObjectiveTo assess whether continuity of care (COC) with a general practitioner (GP) is associated with mortality and hospital admissions for older patients We argue that the conventional continuity measure may overestimate these associations. To better reflect COC as a GP quality indicator, we present an alternative, service-based measure.DesignRegistry-based, population-level longitudinal cohort study.SettingLinked data from Norwegian administrative healthcare registries, including 3989 GPs.Participants757 873 patients aged 60–90 years with ≥2 contacts with a GP during 2016 and 2017.Main outcome measureAll-cause emergency hospital admissions, emergency admissions for ambulatory care sensitive conditions, and mortality, in 2018.ResultsWe assessed COC using the conventional usual provider of care index (UPCpatient) and an alternative/supplementary index (UPCGP list) based on the COC for all other patients enlisted with the same preferred GP.For both indices, the mean index score was 0.78. Our model controls for demographic and socioeconomic characteristics, prior healthcare use and municipality-fixed effects. Overall, UPCGP list shows a much weaker association between COC and the outcomes. For both indices, there is a negative relationship between COC and hospital admissions. A 0.2-point increase in the index score would reduce admissions for ambulatory care sensitive conditions by 8.1% (CI 7.1% to 9.1%) versus merely 1.9% (0.2% to 3.5%) according to UPCpatient and UPCGP list, respectively. Using UPCGP list, we find that mortality is no longer associated with COC. There was greater evidence for an association between COC and all-cause admissions among patients with low education.ConclusionsA continuity measure based on each patient’s contacts with own preferred GP may overestimate the importance of COC as a feature of the GP practice. An alternative, service-based measure of continuity could be suitable as a quality measure in primary healthcare. Facilitating continuity should be considered a health policy measure to reduce inequalities in health.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e028744 ◽  
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.

scholarly journals Depression and risk of hospitalisations and rehospitalisations for ambulatory care-sensitive conditions in Denmark: a population-based cohort study

BMJ Open ◽  
2015 ◽  
Vol 5 (12) ◽  
pp. e009878 ◽  
Author(s):  
Dimitry S Davydow ◽  
Morten Fenger-Grøn ◽  
Anette Riisgaard Ribe ◽  
Henrik Søndergaard Pedersen ◽  
Anders Prior ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ambulatory Care ◽  
Population Based ◽  
Ambulatory Care Sensitive Conditions ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

scholarly journals Admissions for ambulatory care sensitive conditions on rural islands and their association with patient experience: a multicentred prospective cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e030101 ◽  
Author(s):  
Makoto Kaneko ◽  
Takuya Aoki ◽  
Masafumi Funato ◽  
Keita Yamashiro ◽  
Kaku Kuroda ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Cohort Study ◽  
Ambulatory Care ◽  
Patient Experience ◽  
Prospective Cohort Study ◽  
Rural Areas ◽  
Prospective Cohort ◽  
Ambulatory Care Sensitive Conditions ◽  
Ambulatory Care Sensitive

ObjectivesThe rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX.DesignMulticentred, prospective, cohort studySettingThis study was conducted on five rural islands in Okinawa, Japan.ParticipantsThe study participants were all island inhabitants aged 65 years or older.Primary outcome measuresThis study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1 year.ResultsOf 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient’s PX scores (OR per 1 SD increase=1.62, 95% CI 1.02–2.61).ConclusionsPhysicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient–doctor relationships on the rural islands.

scholarly journals The Victorian Ambulatory Care Sensitive Conditions Study: reducing demand on hospital services in Victoria

2002 ◽  
Vol 25 (2) ◽  
pp. 71 ◽  
Author(s):  
Zahid Ansari ◽  
Norman Carson ◽  
Adrian Serraglio ◽  
Toni Barbetti ◽  
Flavia Cicuttini
Keyword(s):  
Ambulatory Care ◽  
Pneumococcal Pneumonia ◽  
Diabetes Complications ◽  
Hospital Admissions ◽  
Ambulatory Setting ◽  
Ambulatory Care Sensitive Conditions ◽  
Hospital Services ◽  
Admission Rates ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Ambulatory Care Sensitive Conditions (ACSCs) are those for which hospitalisation is thought to be avoidable ifpreventive care and early disease management are applied, usually in the ambulatory setting. The Victorian ACSCs study offers a new set of indicators describing differentials and inequalities in access to the primary healthcare systemin Victoria. The study used the Victorian Admitted Episodes Dataset (1999-2000) for analysing hospital admissions for diabetes complications, asthma, vaccine preventable influenza and pneumococcal pneumonia. The analyses were performed at the level of Primary Care Partnerships (PCPs). There were 12 100 admissions for diabetes complicationsin Victoria. There was a 12-fold variation in admission rates for diabetes complications across PCPs, with 13 PCPs having significantly higher rates than the Victorian average, accounting for just over half of all admissions (6114) and39 per cent total bed days. Similar variations in admission rates across PCPs were observed for asthma, influenza and pneumococcal pneumonia. This analysis, with its acknowledged limitations, has shown the potential for using theseindicators as a planning tool for identifying opportunities for targeted public health and health services interventions in reducing demand on hospital services in Victoria.

Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities

2021 ◽  
Vol 126 (3) ◽  
pp. 203-215
Author(s):  
Kimberly G. Phillips ◽  
Jeanne S. Wishengrad ◽  
Andrew J. Houtenville
Keyword(s):  
Developmental Disabilities ◽  
Ambulatory Care ◽  
Hospital Admissions ◽  
International Classification Of Diseases ◽  
Care Utilization ◽  
Ambulatory Care Sensitive Conditions ◽  
Intellectual And Developmental Disabilities ◽  
Inpatient Hospitalizations ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Abstract Inpatient hospitalizations for ambulatory care sensitive conditions (ACSC) among beneficiaries with and without intellectual and developmental disabilities (IDD) were examined using Medicaid and commercial claims from 2010–2014 in New Hampshire. IDD was defined with International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes using algorithms from the Centers for Medicare and Medicaid Services, and inpatient encounters were identified using the Healthcare Effectiveness Data and Information Set. In adjusted analyses, beneficiaries with IDD had more hospitalizations for ACSC than those without IDD in both insurance groups. Differences in patterns of ACSC prevalence, comorbidities, and hospital admissions between the commercially and Medicaid-insured groups show the value of using all-payer claims data, when possible, to understand health needs and health care utilization of insurance beneficiaries with IDD.

scholarly journals Regional Characteristics of Hospital Admissions and Outpatients Visits with Arterial Hypertension from the Point of the WHO Concept of Ambulatory Care Sensitive Conditions

2020 ◽  
Vol 16 (6) ◽  
pp. 948-957
Author(s):  
A. V. Kontsevaya ◽  
Yu. V. Doludin ◽  
M. B. Khudyakov ◽  
O. M. Drapkina
Keyword(s):  
Arterial Hypertension ◽  
Ambulatory Care ◽  
Hospital Admissions ◽  
Federal District ◽  
Ambulatory Care Sensitive Conditions ◽  
North Caucasus ◽  
The North ◽  
Federal Districts ◽  
Ambulatory Care Sensitive

Aim. To analyze hospital admission and ambulatory care of the patients with arterial hypertension (AH) in federal districts and regions from the perspective of the WHO concept of diseases, which can be treated in ambulatory settings (ambulatory care sensitive conditions, ACSC).Material and methods. For analysis we used data from annual forms of federal statistical monitoring (12 and 14), which includes data on hospital admissions with hypertension in federal districts and separate regions in 2017. Hypertension included diseases characterized by raised blood pressure, ICD10: I10-I13.Results. We performed the analysis of 12 and 14 forms per districts and regions of the Russian Federation. Regions with increased hospitalization rates and an increased ratio of the hospitalizations to number to outpatients visits were identified. High variability of these indicators was observed both among both between regions and federal districts. The values of the ratio indicator vary from 0.0131 in the Nizhny Novgorod Region to 0.0234 in the Chechen Republic. The average value of the ratio in the federal district varies from 0.032 in the Volga Federal District to 0.119 in the North Caucasus Federal District. In the North Caucasus and Far East Federal District the value of the indicator is significantly higher than in other districts.Conclusion. Assessing diseases which can be treated in ambulatory setting scan be one of the tools for evaluating the quality of medical care in primary care facilities. However, before including ACSC as an indicator of the quality of health care delivery, a deeper understanding of the reasons that can impact its rates is required.

scholarly journals Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

2015 ◽  
Vol 49 (1) ◽  
pp. 44-53 ◽  
Author(s):  
Kelly Holanda Prezotto ◽  
Maria Marta Nolasco Chaves ◽  
Thais Aidar de Freitas Mathias
Keyword(s):  
Ambulatory Care ◽  
Hospital Admissions ◽  
Age Groups ◽  
Ambulatory Care Sensitive Conditions ◽  
Age Group ◽  
Health Region ◽  
Unified Health System ◽  
Using Data ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

OBJECTIVE to describe hospital admissions for ambulatory care sensitive conditions in children under five years of age in the State of Paraná, Brazil by condition type, age group and health region. METHOD a temporal ecological study was conducted using data from the Unified Health System Hospital Information System for the period 2000 to 2011. Conditions were grouped in accordance with the list of ambulatory care sensitive conditions in Brazil. RESULTS there was an increase in the rate of admissions for ambulatory care sensitive conditions in all age groups in 50% of the health regions, with a marked increase in children under the age of one. Pneumonia, gastroenteritis and asthma were the main causes of admissions. There was an increase in the proportion of overall admissions accounted for by pneumonia and gastroenteritis. CONCLUSION the increase in admissions reveals the need for actions to improve access to primary healthcare and provide effective treatment of the main ambulatory care sensitive conditions in order to prevent hospital admissions among children.

scholarly journals 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

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Emily Eyles ◽  
Maria Theresa Redaniel ◽  
Sarah Purdy ◽  
Kate Tilling ◽  
Yoav Ben-Shlomo
Keyword(s):  
Mental Health ◽  
Ambulatory Care ◽  
Hospital Admissions ◽  
Ambulatory Care Sensitive Conditions ◽  
Linear Regression Models ◽  
Practice Level ◽  
People With Dementia ◽  
Avoidable Admissions ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

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.

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