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Understanding geographical variations in health system performance: a population-based study on preventable childhood
Pushkar Raj Silwal1, Daniel Exeter2, Tim Tenbensel3
1Health Systems Department, The University of Auckland, Auckland, New Zealand p.silwal@auckland.ac.nz.
Insights
Childhood ambulatory sensitive hospitalisation (ASH) shows minimal variation between districts, with ethnicity and deprivation being stronger predictors than geography. Further research is needed to understand DHB-level performance variations.
Area of Science:
- Public Health
- Health Services Research
- Pediatric Health
Background:
- Childhood ambulatory sensitive hospitalisation (ASH) rates can indicate primary care effectiveness.
- Understanding interdistrict variations in ASH is crucial for targeted health interventions.
- Previous studies have explored general ASH trends, but childhood-specific variations require focused investigation.
Purpose of the Study:
- To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over a decade (2008-2018).
- To identify factors contributing to these variations in New Zealand.
- To explore the relationship between ASH and sociodemographic variables, geography, and health system inputs.
Main Methods:
- An observational, population-based study utilizing New Zealand's Primary Health Organisation Enrolment Collection and National Minimum Dataset hospital events databases.
- Analysis included all children aged 0-4 years enrolled between 2008 and 2018.
- Statistical methods assessed variability at the District Health Board (DHB) level and the influence of various factors.
Main Results:
- Only 1.4% of the variability in childhood ASH risk was explained at the DHB level, with a median odds ratio of 1.23.
- No consistent national time trend was observed for adjusted childhood ASH, though DHBs showed differing trajectories.
- Ethnicity (Pacific children) and deprivation were stronger predictors of childhood ASH than geographic or health system variables.
Conclusions:
- Interdistrict variations in childhood ASH are minimal and not significantly explained by DHB-level factors alone.
- Sociodemographic variables partially explain variations but do not fully account for them.
- Childhood ASH offers insights into acute conditions sensitive to primary care, but further data is needed to confirm DHB performance variations.
Objective:
To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years.
Design:
Observational population-based study over 2008-2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases.
Setting:
New Zealand primary and secondary care.
Participants:
All children aged 0-4 years enrolled in the PHO Enrolment Collection from 2008 to 2018.
Main Outcome Measure:
ASH.
Results:
Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables.
Conclusion:
The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
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