scholarly journals Associations between attainment of incentivised primary care indicators and emergency hospital admissions among type 2 diabetes patients: a population-based historical cohort study

2021 ◽  
pp. 014107682110051
Author(s):  
Laura H Gunn ◽  
Ailsa J McKay ◽  
Mariam Molokhia ◽  
Jonathan Valabhji ◽  
German Molina ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Historical Cohort ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Emergency Hospital Admissions ◽  
Quality And Outcomes ◽  
Quality And Outcomes Framework

Objectives England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions. Design Historical cohort study. Setting A total of 330 English primary care practices, 2010–2017, using UK Clinical Practice Research Datalink. Participants A total of 84,441 adults with type 2 diabetes. Main Outcome Measures The primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission. Results There were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89–0.92; p < 0.001 and 0.87; 95% CI 0.86–0.89; p < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96–0.99; p = 0.001). Strong associations were found between completing 7–9 (vs. either 4–6 or 0–3) National Diabetes Audit processes and lower rates of all admission outcomes ( p-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductions in all types of emergency admissions by 22% to 26%. Meeting the HbA1c or cholesterol Quality and Outcomes Framework indicators, or completing 7–9 National Diabetes Audit processes, was also associated with longer time-to-unplanned all-cause, diabetes and cardiovascular admissions. Conclusions Attaining Quality and Outcomes Framework-defined diabetes intermediate outcome thresholds, and comprehensive completion of care processes, may translate into considerable reductions in emergency hospital admissions. Out-of-hospital diabetes care optimisation is needed to improve implementation of core interventions and reduce unplanned admissions.

scholarly journals SP3.1.5 Variation and predictors of emergency surgery in emergency hospital admissions from the Emergency Surgery Or Not (ESORT) study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Andrew Hutchings ◽  
Stephen O'Neill ◽  
Silvia Moler Zapata ◽  
Neil Smart ◽  
Robert Hinchliffe ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Diverticular Disease ◽  
Emergency Surgery ◽  
Hospital Admissions ◽  
Abdominal Wall Hernia ◽  
Demographic Characteristics ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Asian Patients

Abstract Aims To assess variation in use of emergency surgery (ES) for emergency hospital admissions with acute appendicitis, cholelithiasis, diverticular disease, abdominal wall hernia or intestinal obstruction. Methods Cohorts were extracted from Hospital Episode Statistics for 136 acute NHS trusts in England. Clinical panel consensus defined ES for emergency admissions between 1/4/2010 and 31/12/2019. The association of socio-demographic characteristics with ES use was estimated by multivariable logistic regression, with adjustment for comorbidity, frailty, diagnosis and trust. Results The cohort sizes ranged from 49,385 (hernia) to 184,777 (appendicitis) patients. ES was less likely for: patients aged over 80, with odds ratios (ORs) across conditions from 0.15 to 0.84 versus those aged under 40; the most deprived, ORs 0.83 to 0.92, versus least deprived; and Asian patients, ORs 0.72 to 0.88, versus White patients. Black patients were less likely to have emergency surgery for appendicitis (OR 0.78) and cholelithiasis (OR 0.78). Females were less likely to have ES for appendicitis (OR 0.94 versus males), but more likely to have surgery for intestinal obstruction (OR 1.29), hernia (OR 1.13) and cholelithiasis (OR 1.22). Unexplained variation in ES across trusts, remained after case-mix adjustment, and was greatest for cholelithiasis (median of 16%, 10 to 90 centile 5%-34%), and hernia (61%, 52%-71%), followed by intestinal obstruction (29%, 24%-36%). appendicitis (93%, 89%-95%), and diverticular disease (15%, 11%-20%). Conclusions The socio-demographic characteristics of emergency admissions are associated with the likelihood of receiving ES. Variation in ES use between NHS trusts remained after adjustment for demographic and clinical characteristics.

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

Heart ◽  
2019 ◽  
Vol 106 (5) ◽  
pp. 374-379 ◽  
Author(s):  
Jennifer Downing ◽  
Tanith C Rose ◽  
Pooja Saini ◽  
Bashir Matata ◽  
Zoe McIntosh ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Length Of Stay ◽  
Hospital Admissions ◽  
Controlled Study ◽  
Rehabilitation Service ◽  
Control Group ◽  
Community Based ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Emergency Hospital Admissions

ObjectiveTo examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England.MethodsA longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, 5 years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay and re-admission rates for cardiovascular disease (CVD).ResultsFindings show that the intervention was associated with 66 fewer emergency CVD admissions per 100 000 population per year (95% CI 22.13 to 108.98) in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed.ConclusionThis consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions.

scholarly journals Depression predicts future emergency hospital admissions in primary care patients with chronic physical illness

2016 ◽  
Vol 82 ◽  
pp. 54-61 ◽  
Author(s):  
Elspeth A. Guthrie ◽  
Chris Dickens ◽  
Amy Blakemore ◽  
Jennifer Watson ◽  
Carolyn Chew-Graham ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Physical Illness ◽  
Chronic Physical Illness ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Primary Care Patients

scholarly journals Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas

2016 ◽  
Vol 22 (2) ◽  
pp. 83-90 ◽  
Author(s):  
Jessica Sheringham ◽  
Miqdad Asaria ◽  
Helen Barratt ◽  
Rosalind Raine ◽  
Richard Cookson
Keyword(s):  
Primary Care ◽  
Local Authority ◽  
Hospital Admissions ◽  
Socioeconomic Inequality ◽  
Area Deprivation ◽  
Term Care ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Administrative Area ◽  
Over Time

Objectives Reducing health inequalities is an explicit goal of England’s health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age–sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in inequality. Conclusions Local equity performance in reducing inequality in emergency admissions varies both geographically and over time. Identifying this variation could provide insights into which local delivery strategies are most effective in reducing such inequalities.

scholarly journals Evaluating the Effectiveness of a Local Primary Care Incentive Scheme: A Difference-in-Differences Study

2021 ◽  
pp. 107755872110352
Author(s):  
Esmaeil Khedmati Morasae ◽  
Tanith C. Rose ◽  
Mark Gabbay ◽  
Laura Buckels ◽  
Colette Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Financial Incentive ◽  
Emergency Admission ◽  
Difference In Differences ◽  
Emergency Admissions ◽  
North West ◽  
Admission Rates ◽  
The North ◽  
Improvement Scheme

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.

scholarly journals Impact of a community respiratory service on emergency hospital admissions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Levin ◽  
D Anderson ◽  
M Milligan ◽  
E Crighton
Keyword(s):  
Hospital Admissions ◽  
Emergency Admission ◽  
Primary Diagnosis ◽  
Relative Reduction ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
North East ◽  
Significant Change ◽  
The Impact

Abstract Background A community respiratory service was implemented in the North West of Glasgow in January 2013, comprising a team of physiotherapists, occupational therapists and support workers, to provide education, self-management advice, and, where appropriate, treatment at home, for COPD patients, to reduce the risk of hospital admission. This study measures the impact of the service on emergency admission to hospital. Methods COPD EAs were defined as emergency admissions to hospital with a primary diagnosis of COPD. Rate of COPD EAs per 1000 population aged 65 years+ in Glasgow City was compared before and after onset of the service, using segmented linear regression with 21-month pre- and 17-month post-intervention periods. COPD EAs for residents of South and North East Glasgow (S+NE) - areas with no such service in place - were used as a comparison group. The model adjusted for the rate of all-cause emergency admissions. Autoregressive terms were included in the model, as well as a fourier term to adjust for seasonality. Models were similarly run for outcome emergency admissions with COPD in any of the other five fields of diagnosis. Results Adjusting for all cause EAs and changes in S+NE, thus factoring out the impact of other initiatives that may have affected emergency admission to hospital, the impact of the service was found to be a level change of -0.33 (-0.51, -0.16) and a trend change of -0.03 (-0.05, -0.02) COPD EAs per 1000 per month. This is equivalent to a predicted reduction due to the service of -0.88 COPD EAs per 1000 popn per month, in March 2015, and a relative reduction of 35.8%. Rate of COPD EAs per month reduced over time after the introduction of the service (from the point of full staffing). Rate of EAs with COPD in a field of diagnosis other than primary saw no significant change in level or trend associated with the service. Conclusions The community respiratory service was associated with a significant reduction in the rate of COPD EAs. Key messages The Community Respiratory service was associated with reductions in emergency hospital admissions with COPD as a primary diagnosis. There was no significant change in emergency admissions with COPD as a secondary diagnosis, suggesting hospital attendance for patients with COPD overall reduced following the intervention.

scholarly journals Influence of Pharmaceutical Copayment on Emergency Hospital Admissions: A 1978–2018 Time Series Analysis in Spain

2021 ◽  
Vol 18 (15) ◽  
pp. 8009
Author(s):  
Antonio Palazón-Bru ◽  
Miriam Calvo-Pérez ◽  
Pilar Rico-Ferreira ◽  
María Anunciación Freire-Ballesta ◽  
Vicente Francisco Gil-Guillén ◽  
...  
Keyword(s):  
Time Series ◽  
Life Expectancy ◽  
Time Series Analysis ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Moving Average ◽  
Emergency Hospital ◽  
Admission Rates ◽  
Series Analysis ◽  
Emergency Hospital Admissions

No studies have evaluated the influence of pharmaceutical copayment on hospital admission rates using time series analysis. Therefore, we aimed to analyze the relationship between hospital admission rates and the influence of the introduction of a pharmaceutical copayment system (PCS). In July 2012, a PCS was implemented in Spain, and we designed a time series analysis (1978–2018) to assess its impact on emergency hospital admissions. Hospital admission rates were estimated between 1978 and 2018 each month using the Hospital Morbidity Survey in Spain (the number of urgent hospital admissions per 100,000 inhabitants). This was conducted for men, women and both and for all-cause, cardiovascular and respiratory hospital discharges. Life expectancy was obtained from the National Institute of Statistics. The copayment variable took a value of 0 before its implementation (pre-PCS: January 1978–June 2012) and 1 after that (post-PCS: July 2012–December 2018). ARIMA (Autoregressive Integrated Moving Average) (2,0,0)(1,0,0) models were estimated with two predictors (life expectancy and copayment implementation). Pharmaceutical copayment did not influence hospital admission rates (with p-values between 0.448 and 0.925) and there was even a reduction in the rates for most of the analyses performed. In conclusion, the PCS did not influence hospital admission rates. More studies are needed to design health policies that strike a balance between the amount contributed by the taxpayer and hospital admission rates.

scholarly journals Comparison of the impact of two national health and social care integration programmes on emergency hospital admissions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marcello Morciano ◽  
Katherine Checkland ◽  
Mary Alison Durand ◽  
Matt Sutton ◽  
Nicholas Mays
Keyword(s):  
Social Care ◽  
Hospital Admissions ◽  
Emergency Admission ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Care Integration ◽  
Health And Social Care ◽  
The Impact ◽  
Expert Support

Abstract Background Policy-makers expect that integration of health and social care will improve user and carer experience and reduce avoidable hospital use. [We] evaluate the impact on emergency hospital admissions of two large nationally-initiated service integration programmes in England: the Pioneer (November 2013 to March 2018) and Vanguard (January 2015 to March 2018) programmes. The latter had far greater financial and expert support from central agencies. Methods Of the 206 Clinical Commissioning Groups (CCGs) in England, 51(25%) were involved in the Pioneer programme only, 22(11%) were involved in the Vanguard programme only and 13(6%) were involved in both programmes. We used quasi-experimental methods to compare monthly counts of emergency admissions between four groups of CCGs, before and after the introduction of the two programmes. Results CCGs involved in the programmes had higher monthly hospital emergency admission rates than non-participants prior to their introduction [7.9 (95% CI:7.8–8.1) versus 7.5 (CI: 7.4–7.6) per 1000 population]. From 2013 to 2018, there was a 12% (95% CI:9.5–13.6%) increase in emergency admissions in CCGs not involved in either programme while emergency admissions in CCGs in the Pioneer and Vanguard programmes increased by 6.4% (95% CI: 3.8–9.0%) and 8.8% (95% CI:4.5–13.1%), respectively. CCGs involved in both initiatives experienced a smaller increase of 3.5% (95% CI:-0.3–7.2%). The slowdown largely occurred in the final year of both programmes. Conclusions Health and social care integration programmes can mitigate but not prevent rises in emergency admissions over the longer-term. Greater financial and expert support from national agencies and involvement in multiple integration initiatives can have cumulative effects.

Effects and costs of predictive risk stratification in primary care: randomised stepped wedge trial

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696941
Author(s):  
Ian Russell ◽  
Kerry Bailey-Jones ◽  
Deborah Burge-Jones ◽  
Jeremy Dale ◽  
Bernadette Diethart ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Stratification ◽  
Hospital Admissions ◽  
Emergency Admission ◽  
Routine Data ◽  
Stepped Wedge ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Patient Reported ◽  
Predictive Risk

BackgroundThe ageing UK population needs safe approaches to reduce emergency hospital admissions. Predictive risk stratification modelling (PRiSM) estimates risk that individuals will suffer emergency admission to hospital within 12 months and selects patients for preventative community care to avoid admissions.AimTo evaluate the introduction of (PRiSM) into primary care.MethodFunded by NIHR, we used randomised stepped wedge design to estimate (cost) effectiveness of introducing PRiSM software into 32 participating practices in urban South Wales, supported by practice-based training, clinical support through two local ‘GP champions’, and technical support through telephone help-desk. Outcome measures included: emergency hospital admissions (primary), other hospital activity, and GP activity, all estimated from routine data; patient-reported SF-12 health-related quality of life scores; and NHS costs.ResultsAcross 230,000 participants, PRiSM implementation increased: emergency hospital admission rates by 1.1% (95% confidence interval [CI] = 1.0% to 1.3%); Emergency Department attendance rates by 3.0% (95%CI = 2.8% to 3.2%); outpatient visit rates by 5.5% (95%CI = 5.1% to 5.8%); GP activity by 1.1% (95% CI = 0.7% to 1.4%); and NHS costs per patient by £76 (95%CI = £46 to £106). Questionnaires completed by 1400 randomly sampled participants showed that: PRISM improved SF-12 physical scores by 1.5 points (95%CI = 0.8 to 2.2); but not SF-12 mental scores (95%CI = −1.5 points to +0.3). The direct cost of introducing PRiSM was £0.11/patient/year.ConclusionThe introduction of PRiSM increased emergency hospital admissions and other NHS activity without clear evidence of benefit.

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