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.

scholarly journals Caracterização e Evolução dos Internamentos Evitáveis em Portugal: Impacto de Duas Abordagens Metodológicas

2015 ◽  
Vol 28 (5) ◽  
pp. 590 ◽  
Author(s):  
João Sarmento ◽  
Conceição Alves ◽  
Paula Oliveira ◽  
Rita Sebastião ◽  
Rui Santana
Keyword(s):  
Ambulatory Care ◽  
Hospital Admissions ◽  
The Elderly ◽  
Ambulatory Care Sensitive Conditions ◽  
Avoidable Admissions ◽  
Potential Improvement ◽  
Health Systems Performance ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

<strong>Introduction:</strong> The aim of this study is to evaluate the health systems performance through the avoidable hospital admissions, once these have gained international relevance. We used two different methods to identify the admissions for Ambulatory Care Sensitive Conditions, describing the Portuguese reality and evolution.<br /><strong>Material and Methods:</strong> Over 12 million hospitalizations were analyzed between 2000 and 2012 using the national hospital discharge databases. We used two different methodologies to identify the hospitalizations for Ambulatory Care Sensitive Conditions, determining their concordance. We also estimated potential improvement scenarios.<br /><strong>Results: </strong>In 2012, 4.4% and 32.4% of the hospitalizations for medical causes were avoidable according to the Canadian and Spanish methodologies respectively. The hospitalizations are more frequent in children and the elderly. The most frequent causes vary according to the age group and methodology. During the analyzed period the rate of admissions has dropped 20% according to the Canadian methodology and increased 16% according to the Spanish methodology. There are regional clusters of performance under and above the national average. The concordance between methodologies is low. The improvement scenarios estimated possible reductions between 20.3% and 53.5% of the hospitalizations.<br /><strong>Discussion:</strong> The avoidable admissions assume a relevant volume in Portugal. Although in theory they are avoidable their complete elimination is a practical impossibility. Their study, however, allows the evaluation and results motorization enabling to establish intervention priorities.<br /><strong>Conclusion:</strong> To have a precise characterization of the avoidable admissions in Portugal it is necessary to achieve consensus on the identification methodology.

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 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 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 Ambulatory care sensitive conditions hospitalization for emergencies rates in Colombia

2019 ◽  
Vol 53 ◽  
pp. 36 ◽  
Author(s):  
Abel E González-Vélez ◽  
Claudia Carolina Colmenares Mejía ◽  
Eduardo Low Padilla ◽  
Sandra Yadira Moreno Marín ◽  
Paola Andrea Rengifo Bobadilla ◽  
...  
Keyword(s):  
Ambulatory Care ◽  
Hospital Admissions ◽  
General System ◽  
Percentage Change ◽  
Ambulatory Care Sensitive Conditions ◽  
Time Interval ◽  
Annual Percentage Change ◽  
Hospitalization Rates ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

OBJECTIVE: To analyze the emergency hospitalizations trend for ambulatory care sensitive conditions between 2011 and 2015 in a health insureance company of the Colombian Social Security General System. METHODS: A log-linear analysis based on age-adjusted hospitalization rates for ambulatory care sensitive conditions in the Entidad Promotora de Salud Sanitas was used to estimate the annual percentage change in these rates and to identify joinponts of the rates. Data was collected from administrative sources. RESULTS: There were 38,530 hospitalizations for ambulatory care sensitive conditions in 26,501 Entidad Promotora de Salud Sanitas enrollees, with a significant decrease in hospitalization rates. The annual percentage change estimated for the period was -9.5% with no significant joinpoints throughout the time interval. CONCLUSIONS: A significant reduction in hospital admissions due to ambulatory care sensitive conditions in Entidad Promotora de Salud Sanitas enrollees were reported for the last five years in this study.

Education level and hospitalization for ambulatory care sensitive conditions: an education approach is required

2019 ◽  
Vol 30 (2) ◽  
pp. 207-212 ◽  
Author(s):  
Alessandra Buja ◽  
Marco Fonzo ◽  
Milena Sperotto ◽  
Elisa De Battisti ◽  
Tatjana Baldovin ◽  
...  
Keyword(s):  
Health Care ◽  
Ambulatory Care ◽  
Formal Education ◽  
Hospital Admissions ◽  
Healthcare Services ◽  
Healthcare Research ◽  
Ambulatory Care Sensitive Conditions ◽  
Educational Approach ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Abstract Background Studies in several different countries and settings suggest that ambulatory care–sensitive conditions (ACSCs)-related hospitalizations could be associated more with socioeconomic variables than with the quality of primary healthcare services. The aim of the present study was to analyze the potential links between education levels or other social determinants and ACSC-related hospitalization rates. Methods We analyzed a total of 467 504 records of ordinary discharges after acute hospitalization in 2015–16 for patients 20–74 years old residing in the Veneto Region. We calculated the prevention quality indicators (PQIs) developed by the Agency for Healthcare Research and Quality. Rate ratios (RRs) and 95% confidence intervals (95% CIs) were estimated with a set of Poisson regressions to measure the relative risk by sociodemographic level. Results Hospitalizations for ACSCs accounted for 3.9% of all hospital admissions (18 436 discharges), and the crude hospitalization rate for ACSCs among 20- to 74-year-olds was 26.6 per 10 000 inhabitants (95% CI, 25.8–27.4). For all conditions, we found a significant association with formal education. In the case of the overall composite PQI#90, e.g. poorly educated people (primary school or no schooling) were at significantly higher risk of hospitalization for ACSCs than the better educated (RR, 4.50; 95% CI, 4.13–4.91). Conclusions Currently available administrative data regarding ACSCs may be used effectively for reveal equity issues in the provision of health care. Our results indicate that an educational approach inside Primary Health Care could address the extra risk for preventable healthcare demands associated with poorly educated patients.

Mortality related to ambulatory care sensitive hospitalisations in Finland

2020 ◽  
Vol 48 (8) ◽  
pp. 839-846
Author(s):  
Veli-Matti Partanen ◽  
Martti Arffman ◽  
Kristiina Manderbacka ◽  
Ilmo Keskimäki
Keyword(s):  
Primary Care ◽  
General Population ◽  
Ambulatory Care ◽  
Excess Mortality ◽  
Hospital Admissions ◽  
Mortality Rates ◽  
Ambulatory Care Sensitive Conditions ◽  
Ambulatory Care Sensitive Condition ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends in the mortality indicating variations in ambulatory care sensitive conditions outcomes. Methods: This retrospective cohort study used individual-level data from national registers concerning ambulatory care sensitive condition hospitalisations. Crude and age-adjusted 365-day mortality rates for the first ambulatory care sensitive condition-related admission were calculated for vaccine-preventable, acute, and chronic ambulatory care sensitive conditions separately, and for three time periods stratified by gender. The mortality rates were also compared to mortality in the general Finnish population to assess the excess mortality related to ambulatory care sensitive condition hospitalisations. Results: The data comprised a total of 712,904 ambulatory care sensitive condition hospital admissions with the crude 365-day mortality rate of 14.2 per 100 person-years. Mortality for those hospitalised for vaccine-preventable conditions was approximately 10-fold compared to the general population and four-fold in chronic and acute conditions. Of the 10 most common ambulatory care sensitive conditions, bacterial pneumonia and influenza and congestive heart failure were associated with highest age-standardised mortality rates. Conclusions: Hospitalisations for ambulatory care sensitive conditions were shown to be associated with excess mortality in patients compared to the general population. Major differences in mortality were found between different types of ambulatory care sensitive condition admissions. There were also minor differences in mortality between hospital districts. These differences are important to consider when using preventable hospital admissions as an indicator of primary care performance.

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