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Explaining variation in hospital admission rates between general practices: cross sectional study
1Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE.
BMJ (Clinical Research Ed.)
|July 10, 1999
Summary
Hospital admission rates vary significantly between general practices, primarily due to patient population differences. Practice-level factors explained little variation, suggesting a need to standardize for patient demographics and hospital usage in healthcare analysis.
Area of Science:
- Health Services Research
- Public Health
- Epidemiology
Background:
- Hospital admission rates exhibit considerable variation across general practices.
- Understanding the drivers of this variation is crucial for equitable healthcare delivery and resource allocation.
Purpose of the Study:
- To quantify inter-practice variation in hospital admission rates.
- To identify patient, hospital, and general practice factors contributing to this variation.
Main Methods:
- Cross-sectional analysis of routine data from Merton, Sutton, and Wandsworth Health Authority.
- Examined 209,136 hospital admissions for 120 general practices (1995-6).
- Analyzed overall, emergency, and elective admission rates.
Main Results:
- A twofold difference in admission rates was observed between the 10th and 90th percentiles, minimally reduced by age/sex standardization.
- Sociodemographic patient factors explained 42% of overall, 45% of emergency, and 25% of elective admission rate variations.
- Deprivation correlated strongly with emergency admissions, raising equity concerns; hospital usage explained significant variation, while practice characteristics explained little.
Conclusions:
- Patient population differences are the primary driver of hospital admission rate variation between general practices.
- General practice characteristics offered limited explanation for admission rate variation.
- Routine standardization for patient population and hospital usage differences is recommended.