Diagnosing Potentially Preventable Hospitalisations (DaPPHne): protocol for a mixed-methods data-linkage study

Abstract

IntroductionRates of potentially preventable hospitalisations (PPH) are used as a proxy measure of effectiveness of, or access to community-based health services. The validity of PPH as an indicator in Australia has not been confirmed. Available evidence suggests that patient-related, clinician-related and systems-related factors are associated with PPH, with differences between rural and metropolitan settings. Furthermore, the proportion of PPHs which are actually preventable is unknown. The Diagnosing Potentially Preventable Hospitalisations study will determine the proportion of PPHs for chronic conditions that are deemed preventable and identify potentially modifiable factors driving these, in order to develop effective interventions to reduce admissions and improve measures of health system performance.Methods and analysisThis mixed methods data linkage study of approximately 1000 eligible patients with chronic PPH admissions to one metropolitan and two regional hospitals over 12 months will combine data from multiple sources to assess the: extent of preventability of chronic PPH admissions; validity of the Preventability Assessment Tool (PAT) in identifying preventable admissions; factors contributing to chronic PPH admissions. Data collected from patients (quantitative and qualitative methods), their general practitioners, hospital clinicians and hospital records, will be linked with routinely collected New South Wales (NSW) Admitted Patient Data Collection, the NSW Registry of Births, Death and Marriages death registration and Australian Bureau of Statistics mortality data. The validity of the PAT will be assessed by determining concordance between clinician assessment and that of a ‘gold standard’ panel. Multivariable logistic regression will identify the main predictor variables of admissions deemed preventable, using study-specific and linked data.Ethics and disseminationThe NSW Population and Health Services Research Ethics Committee granted ethical approval. Dissemination mechanisms include engagement of policy stakeholders through a project Steering Committee, and the production of summary reports for policy and clinical audiences in addition to peer-review papers.

Sociodemographic variations in the amount, duration and cost of potentially preventable hospitalisation for chronic conditions among Aboriginal and non-Aboriginal Australians: a period prevalence study of linked public hospital data

“…The extent to which these differences are amenable to change needs further discussion. By definition, chronic PPH represent opportunities for change through exposure to primary healthcare, notwithstanding a range of individual, societal, clinical and system level factors are related to their occurrence 72 73 and may each be associated with realising this potential. This is supported by studies of risk factor exposure across levels of socioeconomic disadvantage and remoteness.…”

Potentially preventable hospitalisations in children: a comparison of definitions

“…In developing the child definition, conditions were classified as PPHs if clinicians agreed that ≥51% of admissions were realistically preventable 8. Estimates of PPHs are thought to be an overestimation of realistically preventable admissions,28–30 but the proportion of admissions that are actually preventable is unknown 29. Our ability to determine preventability may improve if information on socioeconomic position, environment, external causes and primary care contact were routinely collected.…”

Visualising linked health data to explore health events around preventable hospitalisations in NSW Australia

“…Patients may face a number of barriers, such as waiting times and cost, that in Australia are often not proportional to patients' need. 46 However, data on service use are an integral part of understanding patients' access to healthcare, 46 and studies further integrating patient and doctor experiences and measures of health need 47 will help consolidate our understanding of the true ‘preventability’ of these admissions.…”