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Measuring potentially avoidable and ambulatory care sensitive hospitalisations in New Zealand children using a newly
Elizabeth Craig1, Philippa Anderson, Gary Jackson
1Department of Women's and Children's Health, Dunedin School of Medicine, PO Box 913, Dunedin, New Zealand. Liz.Craig@otago.ac.nz
Insights
Potentially Avoidable (PAH) and Ambulatory Care Sensitive (ACSH) hospitalizations in New Zealand children are high, particularly for infants and those from deprived backgrounds. Policies addressing social determinants of health are crucial for reducing these preventable hospitalizations.
Area of Science:
- Public Health
- Paediatric Healthcare
- Health Services Research
Background:
- Potentially Avoidable (PAH) and Ambulatory Care Sensitive (ACSH) hospitalizations represent a significant burden on healthcare systems.
- Understanding the drivers of these hospitalizations in children is crucial for developing targeted interventions.
- Socioeconomic and ethnic disparities are known to influence health outcomes and healthcare access.
Purpose of the Study:
- To apply newly developed tools to measure PAH and ACSH hospitalizations in New Zealand children.
- To explore the role of underlying health determinants and policies in reducing pediatric hospitalizations.
- To identify specific population groups and conditions contributing to avoidable hospitalizations.
Main Methods:
- Utilized a newly developed tool to categorize pediatric hospitalizations (aged 29 days-14 years) in New Zealand from 2000-2009.
- Included acute, semi-acute, and selected dental condition hospitalizations.
- Analyzed explanatory variables such as age, gender, ethnicity, and socioeconomic deprivation (NZ Deprivation Index).
Main Results:
- During 2005-2009, 47.4% of acute pediatric hospitalizations were PAH and 34.3% were ACSH.
- Dental conditions and gastroenteritis were leading causes of PAH and ACSH.
- PAH and ACSH rates were highest in infants and young children, and disproportionately affected children from deprived areas, and Pacific and Maori ethnicities.
Conclusions:
- Significant social gradients in ACSH highlight the need for improved primary care access for Pacific and Maori children in deprived areas.
- Policies must ensure immediate and after-hours primary care access, especially for infectious and respiratory conditions.
- Strategies to reduce the community's underlying disease burden are essential to prevent ambulatory-sensitive hospitalizations.
Objectives:
To use a newly developed tool to measure Potentially Avoidable (PAH) and Ambulatory Care Sensitive (ACSH) Hospitalisations in New Zealand children. To consider whether these tools provide any insights into the role policies or programmes which address the underlying determinants of health (e.g. poor housing, exposure to cigarette smoke, child poverty) might play in reducing hospitalisations in this age group.
Methods:
All acute and semi acute (<1 week of referral) hospitalisations in New Zealand children aged 29 days-14 years, during 2000-2009 were included, along with all hospitalisations for selected dental conditions. The newly developed PAH and ACSH tools were used to determine category membership, with explanatory variables including age, gender, ethnicity and NZ Deprivation index decile.
Results:
During 2005-2009, 47.4% of all acute paediatric hospitalisations were considered to be PAH, 34.3% to be ACSH, and 9.7% to be non-avoidable. A further 42.9% were for non-classified conditions. Dental conditions and gastroenteritis were the leading causes of both PAH and ACSH. PAH and ACSH were highest in infants and one year olds, while non-avoidable hospitalisations were more evenly distributed throughout childhood. PAH and ACSH were higher for those from deprived areas and for Pacific and Maori children. Socioeconomic differences for non-avoidable hospitalisations were less marked, with rates being lowest in Maori and Asian children.
Discussion:
Large social gradients in ACSH suggest that New Zealand needs to implement policies to increase access to primary care for Pacific and Maori children and those living in more deprived areas. With the majority of presentations being for acute onset infectious and respiratory diseases, such policies must take into account the need for immediate (i.e. same day) and after hours access to primary care. The narrow windows of opportunity (hours-days) available for primary care to prevent hospitalisations for ambulatory sensitive conditions also suggests that New Zealand needs to develop policies and strategies to reduce the underlying burden of disease in the community.
