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A system-wide approach to explaining variation in potentially avoidable emergency admissions: national ecological
Alicia O'Cathain1, Emma Knowles, Ravi Maheswaran
1Medical Care Research Unit, ScHARR, School of Health and Related Research (ScHARR), University of Sheffield, , Sheffield, UK.
BMJ Quality & Safety
|August 2, 2013
Summary
Avoidable emergency admissions are significantly influenced by socioeconomic factors like unemployment and urban/rural status. Targeted interventions in deprived communities and improved healthcare service utilization can reduce these admissions.
Area of Science:
- Healthcare Management
- Public Health
- Health Services Research
Background:
- Many emergency hospital admissions are preventable with effective management of health conditions.
- Acute exacerbations require timely intervention from emergency and urgent care services.
Purpose of the Study:
- To identify system-level factors contributing to variations in avoidable emergency admission rates.
- Analyze age- and sex-adjusted admission rates for conditions with high potential for avoidance.
Main Methods:
- A national ecological study was conducted across 152 emergency and urgent care systems in England.
- Hospital Episode Statistics data from 2008-2011 were used to calculate admission rates.
- Statistical analysis identified factors associated with admission rate variations.
Main Results:
- Over 3.2 million relevant admissions occurred (22% of all emergency admissions).
- A 3.4-fold variation in age-sex adjusted admission rates was observed between systems.
- Socioeconomic factors (unemployment, urban/rural status) explained 75% of variation; healthcare system factors explained an additional 10%.
Conclusions:
- Interventions should prioritize deprived communities to reduce avoidable admissions.
- Optimizing emergency department, ambulance, and primary care services can further decrease preventable admissions.
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