scholarly journals Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities

2018 ◽  
Vol 68 (676) ◽  
pp. e803-e810 ◽  
Author(s):  
Julian Abel ◽  
Helen Kingston ◽  
Andrew Scally ◽  
Jenny Hartnoll ◽  
Gareth Hannam ◽  
...  
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Complex Intervention ◽  
Hospital Admissions ◽  
Health Improvement ◽  
Social Approach ◽  
Emergency Admissions ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions ◽  
The Impact

BackgroundReducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital.AimTo evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital.Design and settingA cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017.MethodPatients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome.ResultsThere was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P<0.001).ConclusionThe complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.

scholarly journals Understanding the impact of the COVID-19 pandemic on a socially deprived UK coastal town: a preliminary exploratory analysis of health and socioeconomic data

2021 ◽  
Author(s):  
Maddy French ◽  
Mark Spencer ◽  
Mike Walker ◽  
Afzal Patel ◽  
Neil Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Exploratory Analysis ◽  
Social Outcomes ◽  
Socioeconomic Outcomes ◽  
Chi Squared ◽  
Service Activity ◽  
Indirect Impacts ◽  
The Uk ◽  
The Impact

Introduction In addition to the direct impact of COVID-19 infections on health and mortality, a growing body of literature indicates there are wide-ranging indirect impacts of the COVID-19 pandemic and associated public health measures on population health and wellbeing. Exploring these indirect impacts in the context of a socially deprived UK coastal town will help identify priority areas to focus COVID-19 recovery efforts on. Methods Data on primary care diagnosis, hospital admissions, and several socioeconomic outcomes between 2016 and Spring 2021 in the UK town of Fleetwood were collected and analysed in an exploratory analysis looking at pre- and post- COVID-19 patterns in health and social outcomes. Weekly and monthly trends were plotted by time and differences between periods examined using Chi-squared and t-tests. Results Initial falls in hospital admissions and diagnoses of conditions in primary care in March 2020 were followed by sustained changes to health service activity for specific diagnostic and demographic groups, including for chronic kidney disease and young people. Increases in the number of people receiving Universal Credit and children eligible for free school meals appear to be greater for those in the least deprived areas of the town. Discussion These exploratory findings provide initial evidence of the sustained impact of the pandemic across several health and social outcomes. Examining these trends in multivariate analyses will further test these associations and establish the strength of the medium term impact of the pandemic on the population of this coastal town. Advanced modelling of this data is ongoing and will be published shortly.

DSRIP’s innovation and collaboration in population health management: A cross-sectional segmented time series model

2019 ◽  
Vol 33 (1) ◽  
pp. 2-12
Author(s):  
Amrita Gopinath Shenoy
Keyword(s):  
Time Series ◽  
Population Health ◽  
Development Program ◽  
Hospitalization Rate ◽  
Health Improvement ◽  
Infrastructure Development ◽  
Cross Sectional ◽  
Preventable Hospitalization ◽  
Hospitalization Rates ◽  
The Impact

Texas Medicaid Section 1115 waiver approved Delivery System Reform Incentive Payment (DSRIP) program has four categories, namely infrastructure development, program innovation and redesign, reporting of quality improvement outcomes, and population health improvement. A metric of the fourth category, preventable hospitalization rate, was analyzed for a set of eight diagnostic conditions to assess the impact of DSRIP on participating- and non-participating hospitals over two time periods, pre-DSRIP and post-DSRIP, with the help of a cross-sectional segmented time series regression model. Texas Healthcare Information Collection database was leveraged to obtain preventable hospitalization rate data. The dependent variables were preventable hospitalization rates of eight program-specified conditions and the independent variables were time, intervention, and post-implementation intervention. The overall combined preventable hospitalization rate for DSRIP hospitals was observed to decrease by 25.73%, whereas the overall combined preventable hospitalization rate for non-DSRIP hospitals was observed to increase by 37.57%. DSRIP hospitals had invested in coordinating healthcare projects and were subsequently reimbursed by the state for healthcare improvements. The implementation of DSRIP may have had the capacity to decrease preventable hospitalization rates in regions wherein its adoption may have improved the health of the population.

scholarly journals General practitioners’ and out-of-hours doctors’ role as gatekeeper in emergency admissions to somatic hospitals in Norway: registry-based observational study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jesper Blinkenberg ◽  
Sahar Pahlavanyali ◽  
Øystein Hetlevik ◽  
Hogne Sandvik ◽  
Steinar Hunskaar
Keyword(s):  
General Practitioners ◽  
Hospital Admissions ◽  
Significant Proportion ◽  
Emergency Admission ◽  
Public Healthcare ◽  
Malignant Neoplasms ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Admissions ◽  
The Impact

Abstract Background Primary care doctors have a gatekeeper function in many healthcare systems, and strategies to reduce emergency hospital admissions often focus on general practitioners’ (GPs’) and out-of-hours (OOH) doctors’ role. The aim of the present study was to investigate these doctors’ role in emergency admissions to somatic hospitals in the Norwegian public healthcare system, where GPs and OOH doctors have a distinct gatekeeper function. Methods A cross-sectional analysis was performed by linking data from the Norwegian Patient Registry (NPR) and the physicians’ claims database. The referring doctor was defined as the physician who had sent a claim for a consultation with the patient within 24 h prior to an emergency admission. If there was no claim registered prior to hospital arrival, the admission was defined as direct, representing admissions from ambulance services, referrals from nursing home doctors, and admissions initiated by in-hospital doctors. Results In 2014 there were 497,587 emergency admissions to somatic hospitals in Norway after excluding birth related conditions. Direct admissions were most frequent (43%), 31% were referred by OOH doctors, 25% were referred by GPs, whereas only 2% were referred from outpatient clinics or private specialists with public contract. Direct admissions were more common in central areas (52%), here GPs’ referrals constituted only 16%. The prehospital paths varied with the hospital discharge diagnosis. For anaemias, 46–49% were referred by GPs, for acute appendicitis and mental/alcohol related disorders 52 and 49% were referred by OOH doctors, respectively. For both malignant neoplasms and cardiac arrest 63% were direct admissions. Conclusions GPs or OOH doctors referred many emergencies to somatic hospitals, and for some clinical conditions GPs’ and OOH doctors’ gatekeeping role was substantial. However, a significant proportion of the emergency admissions was direct, and this reduces the impact of the GPs’ and OOH doctors’ gatekeeper roles, even in a strict gatekeeping system.

scholarly journals Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027315 ◽  
Author(s):  
Harjeet Kaur Bhachu ◽  
Paul Cockwell ◽  
Anuradhaa Subramanian ◽  
Krishnarajah Nirantharakumar ◽  
Derek Kyte ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Secondary Care ◽  
Health Improvement ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk ◽  
The Health Improvement Network ◽  
The Uk ◽  
The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

scholarly journals The impact of medication reviews conducted in primary care on hospital admissions and mortality - a randomized controlled trial

2019 ◽  
Author(s):  
Veronica Milos Nymberg ◽  
Cecilia Lenander ◽  
Beata Borgström Bolmsjö
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Usual Care ◽  
Frail Elderly ◽  
Hospital Admissions ◽  
Intervention Group ◽  
Control Group ◽  
Randomized Controlled ◽  
Medication Reviews ◽  
The Impact

Abstract Background Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a randomized controlled study. Methods Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results Of the total number of 369 included patients, 182 were randomized to the intervention group and 187 to the control group. Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 36% (HR = 0.64, 95% CI 0.45-0.90), but found no difference on mortality (HR = 1.12, 95% CI 0.78-1.61) between the groups. Conclusion We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on hospital admissions.

scholarly journals Hospital admissions through the National Health System (SUS) in the east of south expanded health region of Minas Gerais, Brazil, between 2014 and 2018

2021 ◽  
Vol 43 ◽  
pp. e15-43558
Author(s):  
Renan Repolês Soares ◽  
Bruno David Henriques ◽  
Catarina Maria Nogueira de Oliveira Sediyama ◽  
Luciana Moreira Lima
Keyword(s):  
Primary Care ◽  
Information System ◽  
Hospital Admissions ◽  
National Health System ◽  
Descriptive Study ◽  
Minas Gerais ◽  
Medical Assistance ◽  
Emergency Admissions ◽  
Health Region ◽  
Imminent Risk

Hospitalizations occur electively in cases with no imminent risk to life or in cases of urgency and emergency, which demand immediate medical assistance. In a Health Region, these hospitalizations are conducted in reference hospitals. This study aimed to analyse hospital admissions in the Eastern South Region of Minas Gerais, by comparing the number of urgency and emergency admissions with elective procedures admissions and with the number of urgency admissions with sensitive to primary care conditions (CSAP). This longitudinal-retrospective-descriptive study was conducted with Hospital Information System (SIH) data relative to the 2014-2018 interval. Altogether, there were registered 129,524 hospitalizations, with 17,546 (13.55%) being elective admissions and 111,978 (86.45%) urgency procedures. Of the urgency hospitalizations total, 20,108 (17.95%) were CASP hospitalizations. The frequency of urgency hospitalization was six times higher than the elective hospitalization one, and even SPCC emergency admissions exceeded the elective hospitalizations offer.

scholarly journals The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries

2016 ◽  
Vol 34 (1) ◽  
pp. 5-12 ◽  
Author(s):  
Tessa Van Loenen ◽  
Marjan J. Faber ◽  
Gert P. Westert ◽  
Michael J. Van den Berg
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Care Organization ◽  
Primary Care Organization ◽  
The Impact

Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

2016 ◽  
Vol 6 (2) ◽  
pp. 108-118
Author(s):  
Harriet Selina Anne Sinclair ◽  
Alison Furey
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Older People ◽  
Social Care ◽  
Hospital Admissions ◽  
Health Check ◽  
Care Needs ◽  
Health And Social Care ◽  
Risk Patients ◽  
Unplanned Hospital Admissions

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.

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