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 Geospatial and seasonal variation of bronchiolitis in England: a cohort study using hospital episode statistics

Thorax ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 262-268 ◽  
Author(s):  
Kate Marie Lewis ◽  
Bianca De Stavola ◽  
Pia Hardelid
Keyword(s):  
Hospital Admissions ◽  
Warning System ◽  
Incidence Rates ◽  
Demographic Characteristics ◽  
North West ◽  
Admission Rates ◽  
The North ◽  
Public Health Messages ◽  
Low Levels ◽  
English National Health

BackgroundRates of hospital admissions for bronchiolitis vary seasonally and geographically across England; however, seasonal differences by area remain unexplored. We sought to describe spatial variation in the seasonality of hospital admissions for bronchiolitis and its association with local demographic characteristics.MethodsSingleton children born in English National Health Service hospitals between 2011 and 2016 (n=3 727 013) were followed up for 1 year. Poisson regression models with harmonic functions to model seasonal variations were used to calculate weekly incidence rates and peak timing of bronchiolitis admissions across English regions and clinical commissioning groups (CCGs). Linear regression was used to estimate the joint association of population density and deprivation with incidence and peak timing of bronchiolitis admissions at the CCG level.ResultsBronchiolitis admission rates ranged from 30.9 per 1000 infant-years (95% CI 30.4 to 31.3) in London to 68.7 per 1000 (95% CI 67.9 to 69.5) in the North West. Across CCGs, there was a 5.3-fold variation in incidence rates and the epidemic peak ranged from week 49.3 to 52.2. Admission rates were positively associated with area-level deprivation. CCGs with earlier peak epidemics had higher population densities, and both high and low levels of deprivation were associated with earlier peak timing.ConclusionsApproximately one quarter of the variation in admission rates and two-fifths of the variation in peak timing of hospital admissions for bronchiolitis were explained by local demographic characteristics. Implementation of an early warning system could help to prepare hospitals for peak activity and to time public health messages.

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 Are more GPs associated with a reduction in emergency hospital admissions?

2020 ◽  
pp. BJGP.2020.0737
Author(s):  
Catia Nicodemo ◽  
Barry McCormick ◽  
FD Richard Hobbs ◽  
Raphael Wittenberg
Keyword(s):  
Fixed Effects ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Emergency Admission ◽  
Population Data ◽  
Local Area ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Access To Primary Care ◽  
Deprived Areas

Background: Recent studies have found an association between access to primary care and accident and emergency attendances, with better access associated with fewer attendances. Analyses of an association with emergency admissions however have produced conflicting findings. Aim: We investigate whether emergency admission rates in an area are associated with (i) the number of GPs, and (ii) mean size of GP practices. Design and Setting: Analysis was conducted utilising Hospital Episode Statistics, the numbers of GPs and GP practices, ONS population data, Quality and Outcomes Framework (QoF) prevalence data, and Index of Multiple Derivation data, from 2004/5 to 2011/12, for all practices in England. Method: Regression analysis of panel data with fixed effects to address (i) a potential two-way relationship between the numbers of GPs and emergency admissions, and (ii) unobservable characteristics of GP practices. Results: There is not a statistically significant relationship between the number of GPs in a local area and the number of emergency admissions when analysing all areas. However, in deprived areas, a higher number of GPs is associated with lower emergency admissions. There is also a lower emergency admission rate in areas in which practices are on average larger, holding constant GP supply. Conclusions In deprived areas an increase in GPs was found to reduce emergency admissions but does not do so elsewhere. Areas in which GPs became concentrated into larger practices experienced reduced levels of emergency admissions, all else equal.

scholarly journals Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S74-S75
Author(s):  
Ritika Devadas ◽  
Douglas Murdie ◽  
Idris Thomas ◽  
Rhona Hannah ◽  
Wiktoria Karbowniczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Psychiatric Services ◽  
Severe Illness ◽  
Healthcare Provision ◽  
North West ◽  
The North ◽  
The Impact

AimsCOVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.

scholarly journals Primary care contact before and after emergency hospitalisation in children in English NHS hospitals: a linked administrative data study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Linda Wijlaars ◽  
Pia Hardelid ◽  
Ruth Gilbert
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Hospital Admissions ◽  
Emergency Admission ◽  
Practice Research ◽  
Control Group ◽  
Clinical Practice Research Datalink ◽  
Emergency Admissions ◽  
Before And After ◽  
Tract Infections

ABSTRACT ObjectivesEmergency admissions for ambulatory care sensitive conditions (ACSCs) are thought to be preventable through preventive or early treatment interventions in primary care. However, evidence shows up to 70% of children with ACSCs admissions have underlying chronic conditions, suggesting that these admissions could be less amenable to primary care prevention than previously thought. We determined the extent to which primary care is involved in care by assessing primary care consultations before and after an emergency admission to hospital for an ACSC. ApproachWe used a national general practice database (Clinical Practice Research Datalink) linked to hospital admissions data (Hospital Episode Statistics) and included children aged 0-19 years with emergency admissions for ACSCs or injury between 2000-2009. ACSCs were defined as acute infections (pneumonia and lower respiratory tract infections (LRTIs), dehydration and gastroenteritis (DGE), urinary tract infections (UTIs)), and asthma. We included injuries as a control group as we did not expect to see an increase in GP consultations for this group before emergency admission. We calculated hospital admission rates by age, gender and area-level deprivation per 1,000 child-years and determined the proportion of children consulting their GP in the week before and week after emergency admission. We examined independent risk factors using zero-inflated negative binomial regression models. ResultsWe extracted data for 1,664,555 children with 32,442 emergency admissions for ACSCs and 39,305 for injuries. There were clear socioeconomic gradients: LRTIs, UTIs and asthma were more prevalent in more deprived children, while rates for DGE and injuries were similar between deprivation quintiles. The majority of children with emergency admissions for ACSCs consulted their GP in the week before admission (range 58.3% (asthma) - 69.5% (LRTIs)), while 24.2% of children with injuries had a GP consultation. Children with ACSCs were more likely to consult their GP after discharge, with 37% (LRTIs) - 46% (UTI) of children consulting in the week after discharge, compared to 22% after injury admission. The proportion of children consulting their GP in the week before an emergency admission decreased. For LRTIs, this decreased from 71.7% in 2000 to 55.2% in 2009. ConclusionThe majority of children consulted a GP both before and after an ACSC emergency admission. This suggest that the degree to which primary care can prevent ACSCs conditions in children might be less than previously thought. Further research is needed to determine which community or hospital based interventions, if any, can reduce ACSC emergency admissions.

scholarly journals Area level impacts on emergency hospital admissions of the integrated care and support pioneer programme in England: difference-in-differences analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026509
Author(s):  
Eilís Keeble ◽  
M Bardsley ◽  
Mary Alison Durand ◽  
Ties Hoomans ◽  
Nicholas Mays
Keyword(s):  
Integrated Care ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Emergency Admission ◽  
Difference In Differences ◽  
Emergency Admissions ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Care And Support ◽  
Health And Social Care

ObjectiveTo examine whether any differential change in emergency admissions could be attributed to integrated care by comparing pioneer and non-pioneer populations from a pre-pioneer baseline period (April 2010 to March 2013) over two follow-up periods: to 2014/2015 and to 2015/2016.DesignDifference-in-differences analysis of emergency hospital admissions from English Hospital Episode Statistics.SettingLocal authorities in England classified as either pioneer or non-pioneer.ParticipantsEmergency admissions to all NHS hospitals in England with local authority determined by area of residence of the patient.InterventionWave 1 of the integrated care and support pioneer programme announced in November 2013.Primary outcome measureChange in hospital emergency admissions.ResultsThe increase in the pioneer emergency admission rate from baseline to 2014/2015 was smaller at 1.93% and significantly different from that of the non-pioneers at 4.84% (p=0.0379). The increase in the pioneer emergency admission rate from baseline to 2015/2016 was again smaller than for the non-pioneers but the difference was not statistically significant (p=0.1879).ConclusionsIt is ambitious to expect unequivocal changes in a high level and indirect indicator of health and social care integration such as emergency hospital admissions to arise as a result of the changes in local health and social care provision across organisations brought about by the pioneers in their early years. We should treat any sign that the pioneers have had such an impact with caution. Nevertheless, there does seem to be an indication from the current analysis that there were some changes in hospital use associated with the first year of pioneer status that are worthy of further exploration.

scholarly journals Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission

2016 ◽  
Vol 22 (1) ◽  
pp. 12-19 ◽  
Author(s):  
Rachel Meacock ◽  
Laura Anselmi ◽  
Søren Rud Kristensen ◽  
Tim Doran ◽  
Matt Sutton
Keyword(s):  
Primary Care ◽  
Emergency Services ◽  
Hospital Admissions ◽  
Severity Of Illness ◽  
Emergency Admission ◽  
Mortality Rates ◽  
Absolute Number ◽  
Lower Probability ◽  
Emergency Admissions ◽  
Accident And Emergency

Objective Patients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends. Method Retrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends. Results Similar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010). Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054). The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths. Conclusions There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.

scholarly journals Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison

2021 ◽  
pp. 135581962110127
Author(s):  
Irina Lut ◽  
Kate Lewis ◽  
Linda Wijlaars ◽  
Ruth Gilbert ◽  
Tiffany Fitzpatrick ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Underlying Disease ◽  
Primary Diagnosis ◽  
Care Quality ◽  
Attendance Rates ◽  
Admission Rates ◽  
Primary Care Quality ◽  
Hospital Administrative

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. Results Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. Conclusions The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

scholarly journals Who is less likely to die in association with improved National Emergency Access Target (NEAT) compliance for emergency admissions in a tertiary referral hospital?

2016 ◽  
Vol 40 (2) ◽  
pp. 149 ◽  
Author(s):  
Clair Sullivan ◽  
Andrew Staib ◽  
Rob Eley ◽  
Bronwyn Griffin ◽  
Rohan Cattell ◽  
...  
Keyword(s):  
Palliative Care ◽  
Mortality Rate ◽  
Older Patients ◽  
Emergency Admission ◽  
Emergency Admissions ◽  
Admission Rates ◽  
Triage Category ◽  
After Hours ◽  
Mode Of Transport ◽  
National Emergency

Objective The aim of the present study was to identify patient and non-patient factors associated with reduced mortality among patients admitted from the emergency department (ED) to in-patient wards in a major tertiary hospital that had previously reported a near halving in mortality in association with a doubling in National Emergency Access Target (NEAT) compliance over a 2-year period from 2012 to 2014. Methods We retrospectively analysed routinely collected data from the Emergency Department Information System (EDIS) and hospital discharge abstracts on all emergency admissions during calendar years 2011 (pre-NEAT interventions) and 2013 (post-NEAT interventions). Patients admitted to short-stay wards and then discharged home, as well as patients dying in the ED, were excluded. Patients included in the study were categorised according to age, time and day of arrival to the ED, mode of transport to the ED, emergency triage category, type of clinical presentation and major diagnostic codes. Results The in-patient mortality rate for emergency admissions decreased from 1.9% (320/17 022) in 2011 to 1.2% (202/17 162) in 2013 (P < 0.001). There was no change from 2011 to 2013 in the percentage of deaths in the ED (0.19% vs 0.17%) or those coded as in-patient palliative care (17.9% vs 22.2%). Although deaths were not associated with age by itself, the mortality rate of older patients admitted to medical wards decreased significantly from 3.5% to 1.7% (P = 0.011). A higher mortality rate was seen among patients presenting to ED triage between midnight and 12 noon than at other times in 2011 (2.5% vs 1.5%; P < 0.001), but this difference disappeared by 2013 (1.3% vs 1.1%; P = 0.150). A similar pattern was seen among patients presenting on weekends versus weekdays: 2.2% versus 1.7% (P = 0.038) in 2011 and 1.3% versus 1.1% (P = 0.150) in 2013. Fewer deaths were noted among patients with acute cardiovascular or respiratory disease in 2013 than in 2011 (1.7% vs 3.6% and 1.5% vs 3.4%, respectively; P < 0.001 for both comparisons). Mode of transport to the ED or triage category was not associated with changes in mortality. These analyses took account of any possible confounding resulting from differences over time in emergency admission rates. Conclusions Improved NEAT compliance as a result of clinical redesign is associated with improved in-patient mortality among particular subgroups of emergency admissions, namely older patients with complex medical conditions, those presenting after hours and on weekends and those presenting with time-sensitive acute cardiorespiratory conditions. What is known about the topic? Clinical redesign aimed at improving compliance with NEAT and reducing time spent within the ED of acutely admitted patients has been associated with reduced mortality. To date, no study has attempted to identify subgroups of patients who potentially derive the greatest benefit from improved NEAT compliance in terms of reduced risk of in-patient death. It also remains unclear as to what extent non-patient factors (e.g. admission practices and differences in coding of palliative care patients) affect or confound this reduced risk. What does this paper add? The present study is the first to reveal that enhanced NEAT compliance is associated with lower mortality among particular subgroups of emergency patients admitted to in-patient wards. These include older patients with complex medical conditions, those presenting after hours or on weekends or those with time-sensitive acute cardiorespiratory conditions. These results took account of any possible confounding resulting from differences over time in emergency admission rates, deaths in the ED, numbers of short-stay ward admissions and coding of palliative care deaths. What are the implications for practitioners? Efforts aimed at improving NEAT compliance and efficiencies at the ED–in-patient interface appear to be worthwhile in reducing in-patient mortality among particular subgroups of emergency admissions at high risk. More research is urgently needed in identifying patient- and system-level factors that predispose to higher mortality rates in such populations, but are potentially amenable to focused interventions aimed at optimising transitions of care at the ED–in-patient interface and increasing NEAT compliance for patients admitted to in-patient wards from the ED.

Drivers of potentially avoidable emergency admissions in Ireland: an ecological analysis

2018 ◽  
Vol 28 (6) ◽  
pp. 438-448 ◽  
Author(s):  
Brenda Lynch ◽  
Anthony P Fitzgerald ◽  
Paul Corcoran ◽  
Claire Buckley ◽  
Orla Healy ◽  
...  
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Private Health Insurance ◽  
Insurance Coverage ◽  
Emergency Admission ◽  
Health Insurance Coverage ◽  
County Level ◽  
Emergency Admissions ◽  
Admission Rates ◽  
System Factors

BackgroundMany emergency admissions are deemed to be potentially avoidable in a well-performing health system.ObjectiveTo measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014–2016.MethodsAdmissions data were used to calculate 2014–2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported.ResultsNationally, potentially avoidable emergency admissions for the period 2014–2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions.ConclusionThe results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates.

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