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Ambulatory sensitive admissions

Frances M Wu, Lisa V Rubenstein, Jean Yoon
BACKGROUND: New models of patient-centered primary care such as the patient-centered medical home (PCMH) depend on high levels of interdisciplinary primary care team functioning to achieve improved outcomes. A few studies have qualitatively assessed barriers and facilitators to optimal team functioning; however, we know of no prior study that assesses PCMH team functioning in relationship to patient health outcomes. PURPOSE: The aim of the study was to assess the relationships between primary care team functioning, patients' use of acute care, and mortality...
March 12, 2018: Health Care Management Review
Kate Brameld, Katrina Spilsbury, Lorna Rosenwax, Helen Leonard, James Semmens
OBJECTIVE: To describe the cause of death together with emergency department presentations and hospital admissions in the last year of life of people with intellectual disability. METHOD: A retrospective matched cohort study using de-identified linked data of people aged 20 years or over, with and without intellectual disability who died during 2009 to 2013 in Western Australia. Emergency department presentations and hospital admissions in the last year of life of people with intellectual disability are described along with cause of death...
February 25, 2018: BMJ Open
JoAnna K Leyenaar, Paul A Rizzo, Emily R O'Brien, Peter K Lindenauer
BACKGROUND: Hospital admission, like hospital discharge, represents a transition of care associated with changes in setting, healthcare providers and clinical management. While considerable efforts have focused on improving the quality and safety of hospital-to-home transitions, there has been little focus on transitions into hospital. OBJECTIVES: Among children hospitalised with ambulatory care sensitive conditions, we aimed to characterise families' experiences as they transitioned from outpatient to inpatient care, identify hospital admission processes and outcomes most important to families and determine how parental perspectives differed between children admitted directly and through emergency departments (ED)...
February 16, 2018: BMJ Quality & Safety
R Cookson, M Asaria, S Ali, R Shaw, T Doran, P Goldblatt
Population-wide health equity monitoring remains isolated from mainstream healthcare quality assurance. As a result, healthcare organizations remain ill-informed about the health equity impacts of their decisions - despite becoming increasingly well-informed about quality of care for the average patient. We present a new and improved analytical approach to integrating health equity into mainstream healthcare quality assurance, illustrate how this approach has been applied in the English National Health Service, and discuss how it could be applied in other countries...
January 6, 2018: Social Science & Medicine
Brandi White, Charles Ellis, Walter Jones, William Moran, Kit Simpson
Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007-2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access...
January 1, 2018: Journal of Health Services Research & Policy
Ian Pope, Sharif Ismail, Benjamin Bloom, Gwyneth Jansen, Helen Burn, David McCoy, Tim Harris
OBJECTIVE: To investigate factors predictive of short hospital admissions and appropriate placement to inpatient versus clinical decision units (CDUs). METHOD: This is a retrospective analysis of attendance and discharge data from an inner-city ED in England for December 2013. The primary outcome was admission for less than 48 hours either to an inpatient unit or CDU. Variables included: age, gender, ethnicity, deprivation score, arrival date and time, arrival method, admission outcome and discharge diagnosis...
January 5, 2018: Emergency Medicine Journal: EMJ
Sergei Muratov, Justin Lee, Anne Holbrook, J Michael Paterson, Jason Robert Guertin, Lawrence Mbuagbaw, Tara Gomes, Wayne Khuu, Priscila Pequeno, Andrew P Costa, Jean-Eric Tarride
INTRODUCTION: Senior high-cost users (HCUs) are estimated to represent 60% of all HCUs in Ontario, Canada's most populous province. To improve our understanding of individual and health system characteristics related to senior HCUs, we will examine incident senior HCUs to determine their incremental healthcare utilisation and costs, characteristics of index hospitalisation episodes, mortality and their regional variation across Ontario. METHODS AND ANALYSIS: A retrospective, population-based cohort study using administrative healthcare records will be used...
December 26, 2017: BMJ Open
Everton Nunes da Silva, Timothy Powell-Jackson
Background: Hospitals account for the major share of health expenditure. Primary healthcare may improve efficiency at the hospital level by reducing avoidable admissions. We examined whether rapid expansion of primary healthcare in the context of Brazil's Family Health Strategy (FHS) was associated with a reduction in avoidable hospitalisations. Methods: We constructed panel data for 5506 municipalities over 2000-2014. Our primary outcome was the rate of avoidable hospitalisations, defined with reference to the official list of ambulatory care sensitive conditions (ACSC)...
2017: BMJ Global Health
Ryan J Coller, Michelle M Kelly, Mary L Ehlenbach, Evan Goyette, Gemma Warner, Paul J Chung
OBJECTIVE: To evaluate ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC), and identify associations with ambulatory care characteristics. Although ACS hospitalizations are potentially preventable in general populations, the specific ambulatory care predictors and influence of medical complexity on them is poorly understood. STUDY DESIGN: Retrospective cohort study of NC-CD and CMC hospitalizations at a children's hospital during 2007-2014, excluding labor/delivery and children over 21 years...
March 2018: Journal of Pediatrics
Célina Lichtl, Thomas Lutz, Joachim Szecsenyi, Kayvan Bozorgmehr
BACKGROUND: Hospitalizations for ambulatory care sensitive (ACS) conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i) the prevalence of ACS hospitalizations, and (ii) the utilization of emergency outpatient services for ACS conditions. METHODS: Using anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study...
November 15, 2017: BMC Health Services Research
Greg Irving, Ana Luisa Neves, Hajira Dambha-Miller, Ai Oishi, Hiroko Tagashira, Anistasiya Verho, John Holden
OBJECTIVE: To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. DESIGN AND OUTCOME MEASURES: This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths...
November 8, 2017: BMJ Open
A Amor-Salamanca, J M Menchon
BACKGROUND: Little is known about the hospitalisation rate of adults with severe/profound intellectual disability (PID) presenting at emergency services or about the appropriateness of hospital admissions in this population. Examining the possible differences in the patterns of hospitalisation between people with PID and those without intellectual disability (ID) may shed light on aspects of health and illness in these patients and may in turn make it possible to differentiate more clearly between mild-moderate ID and PID...
October 29, 2017: Journal of Intellectual Disability Research: JIDR
Jose F Figueroa, Karen E Joynt Maddox, Nancy Beaulieu, Robert C Wild, Ashish K Jha
Background: Little is known about whether potentially preventable spending is concentrated among a subset of high-cost Medicare beneficiaries. Objective: To determine the proportion of total spending that is potentially preventable across distinct subpopulations of high-cost Medicare beneficiaries. Design: Beneficiaries in the highest 10% of total standardized individual spending were defined as "high-cost" patients, using a 20% sample of Medicare fee-for-service claims from 2012...
November 21, 2017: Annals of Internal Medicine
John C Knight, Maria Mathews, Kris Aubrey-Bassler
BACKGROUND: Physician turnover, involving physicians' leaving clinical practice in a specific area, may disrupt continuity of care, leading to poorer health outcomes and greater use of health care services. The purpose of this study was to investigate the relation between family physician retention and avoidable hospital admission for ambulatory-care-sensitive conditions. METHODS: We conducted a population-based cross-sectional study using provincial health administrative data for residents of Newfoundland and Labrador who held a provincial health card between 2001 and 2009...
October 6, 2017: CMAJ Open
Fay J Hosking, Iain M Carey, Stephen DeWilde, Tess Harris, Carole Beighton, Derek G Cook
PURPOSE: Adults with intellectual disabilities experience poorer physical health and health care quality, but there is limited information on the potential for reducing emergency hospital admissions in this population. We describe overall and preventable emergency admissions for adults with vs without intellectual disabilities in England and assess differences in primary care management before admission for 2 common ambulatory care-sensitive conditions (ACSCs). METHODS: We used electronic records to study a cohort of 16,666 adults with intellectual disabilities and 113,562 age-, sex-, and practice-matched adults without intellectual disabilities from 343 English family practices...
September 2017: Annals of Family Medicine
Sabine I Vuik, Gianluca Fontana, Erik Mayer, Ara Darzi
OBJECTIVES: To explore whether hospitalisations for ambulatory care sensitive conditions (ACSCs) are associated with low access to primary care. DESIGN: Observational cohort study over 2008 to 2012 using the Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) databases. SETTING: English primary and secondary care. PARTICIPANTS: A random sample of 300 000 patients. MAIN OUTCOME MEASURES: Emergency hospitalisation for an ACSC...
August 21, 2017: BMJ Open
Hirotaka Kato, Rei Goto
BACKGROUND: Assessing the impact of cost sharing on healthcare utilization is a critical issue in health economics and health policy. It may affect the utilization of different services, but is yet to be well understood. OBJECTIVE: This paper investigates the effects of reducing cost sharing for outpatient services on hospital admissions by exploring a subsidy policy for children's outpatient services in Japan. METHODS: Data were extracted from the Japanese Diagnosis Procedure Combination database for 2012 and 2013...
August 15, 2017: Health Economics Review
Charlotte Weston, Sanjiv Ahluwalia, Paul Bassett, Justin Lock, Stevo Durbaba, Mark Ashworth
Postgraduate general practitioner (GP) training structures have been reorganised with the formation of Health Education England (HEE). We aimed to broaden the findings of previous studies and identify key features of GP training practices. In particular, we wanted to extend previous findings regarding QOF achievement and patient experience derived from the General Practice Patient Survey (GPPS), with recent data on the use of urgent cancer referral pathways ('Two Week Wait', or '2WW,' referrals) and secondary care utilisation by GP training Practices...
July 14, 2017: Education for Primary Care
Meenakshi P Balakrishnan, Jill Boylston Herndon, Jingnan Zhang, Thomas Payton, Jonathan Shuster, Donna L Carden
BACKGROUND: Policymakers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor, and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. OBJECTIVE: The objective was to determine the association of health literacy with preventable ED visits...
September 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Michelle L Bellon, Christopher Barton, Nikki McCaffrey, Denise Parker, Claire Hutchinson
PURPOSE: Seizures are listed as an Ambulatory Care Sensitive Condition (ACSC), where, in some cases, hospitalisation may be avoided with appropriate preventative and early management in primary care. We examined the frequencies, trends and financial costs of first and subsequent seizure-related hospital admissions in the adult and paediatric populations, with comparisons to bronchitis/asthma and diabetes admissions in South Australia between 2012 and 2014. METHODS: De-identified hospital separation data from five major public hospitals in metropolitan South Australia were analysed to determine the number of children and adults admitted for the following Australian Refined Diagnosis Related Groups: seizure related conditions; bronchitis/asthma; and diabetes...
June 10, 2017: Seizure: the Journal of the British Epilepsy Association
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