Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making

Daniels, Lisa M.; Sorita, Atsushi; Kashiwagi, Deanne T.; Okubo, Masashi; Small, Evan; Polley, Eric C.; Sawatsky, Adam P.

doi:10.1007/s11606-017-4285-6

Cited by 18 publications

(24 citation statements)

References 34 publications

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“…10 29 We found significant associations between PEAs and demographic, clinical and care process factors, which have not been identified as objective indicators for PEAs among older adults before. In contrast to previous studies, 29 37 higher age of older patients, a low urgency classification and ED attendance in the weekend was associated with an increased likelihood of a PEA after adjusting for confounding factors. We assume that a higher age, and an increased chance of comorbidities and atypical symptoms, may complicate the physician's clinical assessment, 15 and make decisions to admit the patient possibly more sensitive for error.…”

Section: Open Accesscontrasting

confidence: 99%

Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals

et al. 2020

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ObjectiveOlder adults are hospitalised from the emergency department (ED) without potentially needing hospital care. Knowledge about rates, associative factors and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to determine the rates, associative factors and causes for PEAs of older adults.DesignA mixed-method observational study.SettingThe EDs of two Dutch hospitals.Participants492 patients aged >70 years and hospitalised from the ED.MeasurementsQuantitative data were retrospectively extracted from the electronical medical record over a 1-month period. Admissions were classified (non)preventable based on a standardised approach. Univariate and multivariate multilevel logistic regression analyses were performed to identify possible associations between PEAs and demographic, clinical and care process factors. Qualitative data were prospectively collected by email and telephone interviews and analysed thematically to explore hospital physician’s perceived causes for the identified PEAs.ResultsOf the 492 included cases, 86 (17.5%) were classified as PEA. Patients with a higher age (adjusted OR 1.04, 95% CI 1.01 to 1.08; p=0.04), a low urgency classification (adjusted OR 1.89, 95% CI 1.14 to 3.15; p=0.01), and attending the ED in the weekend (adjusted OR 2.02, 95% CI 1.22 to 3.37; p<0.01) were associated with an increased likelihood of a PEA. 49 physicians were interviewed by telephone and email. Perceived causes for PEAs were related to patient’s attitudes (eg, postponement of medical care at home), provider’s attitudes (eg, deciding for admission after family pressure), health system deficiencies (eg, limited access to community services during out-of-hours and delayed access to inpatient diagnostic resources) and poor communication between primary care and hospital professionals about patient treatment preferences.ConclusionsOur findings contribute to existing evidence that many emergency admissions of older adults are preventable, thereby indicating a possible source of unnecessary expensive, and potentially harmful, hospital care.

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Section: Open Accesscontrasting

confidence: 99%

Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals

et al. 2020

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“…In the Canadian health system, hospitalizations for seven chronic ACSCs are routinely monitored, namely angina, asthma, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes and diabetic complications, epilepsy, and hypertension [3]. Hospitalizations for chronic ACSCs may more specifically indicate insufficient disease management [4][5][6][7][8][9]. Studies have characterized risk factors for ACSC hospitalizations including demographics [10][11][12][13][14][15][16][17][18][19], rurality [5,17,[20][21][22][23][24][25][26], socioeconomic status (SES) [1,5,[15][16][17][26][27][28][29][30][31][32][33][34][35][36][37][38], chronic morbidities [10,16,17,…”

Section: Introductionmentioning

confidence: 99%

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Wallar

Rosella

2020

PLoS ONE

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Hospitalizations for certain chronic conditions are considered avoidable for adult Canadians given effective and timely primary care management. Individual-level risk factors such as income and health behaviours are not routinely collected in most hospital databases and as a result, are largely uncharacterized for avoidable hospitalization at the national level. The aim of this study was to identify and describe demographic, socioeconomic, and health behavioural risk factors for avoidable hospitalizations in Canada using linked data. A national retrospective cohort study was conducted by pooling eight cycles of the Canadian Community Health Survey (2000/2001-2011) and linking to hospitalization records in the Discharge Abstract Database (1999/2000-2012/2013). Respondents who were younger than 18 years and older than 74 years of age, residing in Quebec, or pregnant at baseline were excluded yielding a final cohort of 389,065 individuals. The primary outcome measure was time-to index avoidable hospitalization. Sex-stratified Cox proportional hazard models were constructed to determine effect sizes adjusted for various factors and their associated 95% confidence intervals. Demographics, socioeconomic status, and health behaviours are associated with risk of avoidable hospitalizations in males and females. In fully adjusted models, health behavioural variables had the largest effect sizes including heavy smoking (Male HR 2.65 (95% CI 2.17-3.23); Female HR 3.41 (2.81-4.13)) and being underweight (Male HR 1.98 (1.14-3.43); Female HR 2.78 (1.61-4.81)). Immigrant status was protective in both sexes (Male HR 0.83 (0.69-0.98); (Female HR 0.69 (0.57-0.84)). Adjustment for behavioural and clinical variables attenuated the effect of individual-level socioeconomic status. This study identified several risk factors for time-to-avoidable hospitalizations by sex, using the largest national database of linked health survey and hospitalization records. The larger effect sizes of several modifiable risk factors highlights the importance of prevention in addressing avoidable hospitalizations in Canada.

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“…Admitting or transferring a patient reflects shared clinical decision-making between the referring physician and the accepting physician. 3,4 We have identified that triage discordance is prevalent and that ultimate disposition is often not in alignment with triagist assessment. To our knowledge, this is the first study to report the specific activities of physicians serving in this emerging triagist capacity.…”

Section: Discussionmentioning

confidence: 99%

Characterizing the Role of the “Triagist”: Reasons for Triage Discordance and Impact on Disposition

Amick

Bann

2020

J GEN INTERN MED

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Characterizing Potentially Preventable Admissions: A Mixed Methods Study of Rates, Associated Factors, Outcomes, and Physician Decision-Making

Abstract: Collaboration between EM and GM physicians around patients in the gray zone, focusing on patient risk, cost, and outpatient resources, may provide an avenues for reducing potentially preventable admissions and lowering healthcare spending.

Cited by 18 publications

References 34 publications

Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals

Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals

Risk factors for avoidable hospitalizations in Canada using national linked data: A retrospective cohort study

Characterizing the Role of the “Triagist”: Reasons for Triage Discordance and Impact on Disposition

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