A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions

Busby, John; Purdy, Sarah; Hollingworth, William

doi:10.1186/s12913-015-0964-3

Cited by 88 publications

(105 citation statements)

References 64 publications

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“…The mean and median LOS across Europe were higher than expected from previous studies in individual countries around Europe [10, 26] and showed great variability. This is in keeping with a recent systematic review that showed consistently high variability of COPD LOS across countries in Europe, North America and Australasia [27]. The variability observed in the present study was, however, reduced when the hospital cluster effect (an important consideration in reducing bias from intrinsic institutional factors not measured in the analysis [24]) was accounted for.…”

Section: Discussionsupporting

confidence: 91%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect.The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis.Mean±sd LOS was 8.7±8.3 days (median 7 days, interquartile range 4–11 days). Crude variability between countries was reduced after accounting for clinical factors and the clustering effect. The main factors associated with LOS being longer than the median were related to disease or exacerbation severity, including GOLD class IV (OR 1.77) and use of mechanical ventilation (OR 2.15). Few individual resource variables were associated with LOS after accounting for the hospital cluster effect.This study emphasises the importance of the patients' clinical severity at presentation in predicting LOS. Identifying patients at risk of a long hospital stay at admission and providing targeted interventions offers the potential to reduce LOS for these individuals. The complex interactions between factors and systems were more important that any single resource or organisational factor in determining differences in LOS between hospitals or countries.

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Section: Discussionsupporting

confidence: 91%

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

et al. 2016

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“…Other cluster detection studies using Alberta data have focused on different conditions. [16][17][18][19][20] Although geographic variation in admission rates or length of stay has been identified in multiple studies for ambulatorycare-sensitive conditions, 21 many investigators did not con- Note: CI = confidence interval, COPD = chronic obstructive pulmonary disease, OR = odds ratio.…”

Section: Discussionmentioning

confidence: 99%

Geographic clustering of emergency department presentations for acute coronary syndromes and heart failure in Alberta: a population-based study

2017

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T he emergency department is often the initial point of contact with the health care system for patients with new-onset cardiac conditions or exacerbations of chronic cardiac conditions. Collectively, the most common acute cardiac presentations to the emergency department are acute coronary syndromes (ACSs) and heart failure.1 The literature on these important conditions in the emergency department setting in Canada is surprisingly limited. In particular, geographic variation has not received much attention, and such variation may represent greater severity of illness, lesser availability of health care resources, variation in delivery of health care services or a combination of these factors.The aim of this study was to examine geographic variation in visits by adults (aged ≥ 35 yr) to emergency departments with presentations attributed to ACS or heart failure in Alberta during 2010/11. We have previously identified clusters of patients presenting to the emergency department for atrial fibrillation and flutter 2 and wished to further examine geographic variation in cardiac conditions in Alberta. Methods Study design and settingThis study is a retrospective cohort study using populationbased administrative health databases in Alberta from Apr. 1, 2010, to Mar. 31, 2011. Sources of dataWe extracted data from 5 Alberta administrative health databases: 1) the Morbidity and Ambulatory Care Abstract Reporting for emergency department presentations, 2) the Alberta Health Care Insurance Plan cumulative registry file Geographic clustering of emergency department presentations for acute coronary syndromes and heart failure in Alberta: a population-based study Rhonda Background: Collectively, the most common acute cardiac presentations to emergency departments are acute coronary syndromes (ACSs) and heart failure. We examined geographic variation and clustering in emergency department presentations by adults for ACS or heart failure in Alberta in 2010/11.

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“…Marked variations in outcomes for patients with respiratory disease have also been shown, regionally and between individual general practitioner (GP) practices 1. There is evidence linking the quality of care provided in general practice with unplanned admissions to secondary care,11 and decreased admission rates have been reported in a number of long-term conditions (including COPD and asthma) where GPs were financially incentivised to provide high-quality care 12. Moreover, higher levels of professional education, nurse staffing and clinical recording in primary care are all associated with an improvement in the quality of clinical care for patients with COPD 13.…”

Section: Introductionmentioning

confidence: 99%

Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service

et al. 2016

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IntroductionIn the UK, there is significant variation in respiratory care and outcomes. An integrated approach to the management of high-risk respiratory patients, incorporating specialist and primary care teams' expertise, is the basis for new integrated respiratory services designed to reduce this variation; however, this model needs evaluating.MethodsTo evaluate an integrated service managing high-risk respiratory patients, electronic searches for patients with asthma and chronic obstructive pulmonary disease at risk of poor outcomes were performed in two general practitioner (GP) practices in a local service-development initiative. Patients were reviewed at joint clinics by primary and secondary care professionals. GPs also nominated patients for inclusion. Reviews were delivered to best standards of care including assessments of diagnosis, control, spirometry, self-management, education, medication, inhaler technique and smoking cessation support. Follow-up of routine clinical data collected at 9-months postclinic were compared with seasonally matched 9-months prior to integrated review.Results82 patients were identified, 55 attended. 13 (23.6%) had their primary diagnosis changed. In comparison with the seasonally adjusted baseline period, in the 9-month follow-up there was an increase in inhaled corticosteroid prescriptions of 23.3%, a reduction in short-acting β2-agonist prescription of 33.3%, a reduction in acute respiratory exacerbations of 67.6%, in unscheduled GP surgery visits of 53.3% and acute respiratory hospital admissions reduced from 3 to 0. Only 4 patients (7.3%) required referral to secondary care. Health economic evaluation showed respiratory-related costs per patient reduced by £231.86.ConclusionsPatients with respiratory disease in this region at risk of suboptimal outcomes identified proactively and managed by an integrated team improved outcomes without the need for hospital referral.

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A systematic review of the magnitude and cause of geographic variation in unplanned hospital admission rates and length of stay for ambulatory care sensitive conditions

Cited by 88 publications

References 64 publications

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Understanding variation in length of hospital stay for COPD exacerbation: European COPD audit

Geographic clustering of emergency department presentations for acute coronary syndromes and heart failure in Alberta: a population-based study

Managing complex respiratory patients in the community: an evaluation of a pilot integrated respiratory care service

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