Potentially preventable hospitalisations in children: a comparison of definitions

Area of Science:

• Pediatric Health Services Research
• Public Health Policy
• Hospitalization Epidemiology

Background:

• Potentially preventable hospitalisations (PPHs) are key indicators of healthcare system performance.
• Existing definitions for PPHs, often based on adult criteria, may not accurately capture pediatric hospitalizations.
• Comparing different PPH definitions is crucial for accurate health service evaluation in children.

Purpose of the Study:

• To compare admission rates and cumulative incidence of PPHs in children using the current Australian adult definition versus a child-specific definition from New Zealand.
• To examine the social distribution of PPHs under both definitions.

Main Methods:

• Utilized deidentified, linked data from South Australian public hospitals, birth registries, and perinatal records for children aged 0-10 years (born 2002-2012).
• Calculated PPH admission rates per 1000 person-years and cumulative incidence by age 5.
• Assessed cumulative incidence across indicators of social and health disadvantage.

Main Results:

• The child definition yielded significantly higher PPH admission rates (59.9/1000 person-years) compared to the adult definition (25.6/1000 person-years).
• The disparity between definitions was most pronounced in younger children (age <1).
• Cumulative incidence of PPHs by age 5 was substantially higher with the child definition (25.0%) than the adult definition (12.8%).
• Higher PPH incidence correlated with social and health disadvantage at birth.
• Respiratory conditions and gastroenteritis accounted for a large proportion of the difference in PPH rates between definitions.

Conclusions:

• The child-specific definition identifies a greater burden of potentially preventable hospitalizations in children than the adult definition.
• Respiratory conditions and gastroenteritis are major drivers of pediatric PPHs under the child definition.
• Socioeconomic and health disadvantages at birth are consistently associated with higher PPH risk in children, regardless of the definition used.