Variation in general practice medical admission rates for elderly people

Emergency medical admissions are rising, particularly in the elderly. Variation in admission rates between general practices has received little attention, and requires explanation.

A retrospective review was carried out of emergency medical admissions to the District General Hospital (DGH) and the Community Hospitals (CHs) in West Gloucestershire in subjects over 75 years of age during 3 years. A survey of general practitioner (GP) attitudes to emergency admissions was carried out.

A five-fold spread in DGH and CH admission rates for elderly medical emergencies was found, and a three-fold spread of overall admission rates. Rates were consistent within a practice each year. The spreads of practice mortality rates and myocardial infarction admission rates were smaller. The variation between practices was not explained by the Jarman Index or by attitudes identified in GPs. Practices with high admission rates had slighter higher annual hospital mortality rates, but lower episode fatality rates.

Admission rates show considerable variation between practices, which is only partly explained by morbidity rates, and consistency over 3 years.