Letters
Health services administration
Volume 199 - Issue 6

Sharper tools — chronic conditions and avoidable admission

Authors:  Jo M Longman, Megan E Passey and Dan P Ewald

Med J Aust 2013; 199 (6): 395-396. || doi: 10.5694/mja13.10129
Published online: 16 September 2013
To the Editor: Potentially avoidable hospital admissions are a key concern for every health care system. Admissions for ambulatory care-sensitive conditions (ACSCs) have been used as a proxy measure of potentially avoidable admissions in research and in policy and program development since the early 1990s. Older patients with chronic conditions are the greatest contributors to ACSC admissions, and hospital admissions for ACSCs are particularly burdensome ...
Download PDF (106 KB)
Share: Share on Blue Sky Share on Facebook Share on LinkedIn Share by email

To the Editor: Potentially avoidable hospital admissions are a key concern for every health care system. Admissions for ambulatory care-sensitive conditions (ACSCs) have been used as a proxy measure of potentially avoidable admissions in research and in policy and program development since the early 1990s. Older patients with chronic conditions are the greatest contributors to ACSC admissions, and hospital admissions for ACSCs are particularly burdensome in rural Australia.2

Quantifying chronic ACSC admissions provides a population measure of hospitalisation based on specific admission diagnoses. While this approach offers the opportunity to analyse large administrative datasets and assess broad geographic disparities in admission patterns, assessing the “avoidability” of individual admissions requires something more. Chronic ACSC admissions data cannot articulate the variation in factors contributing to admissions. Examples of this variation include differing opinions between clinicians (within and between hospitals) regarding symptoms that may warrant admission, levels of welfare support available in the community, and accessibility of primary health care services. ACSC admissions cannot, therefore, provide evidence for establishing which interventions might reduce avoidable admissions. Furthermore, the timescale of any notion of avoidability in a chronic ACSC admission is unclear — that is, could the admission have been avoided by providing primary health care on the day of admission, or during the months, years or decades before admission?

To assess the use of chronic ACSC admissions data as a measure of avoidable admission, we need to: quantify and describe the proportion of these admissions that are avoidable; better understand the antecedents to avoidable admissions; better understand how these admissions differ from unavoidable chronic ACSC admissions; establish which chronic ACSC admissions are more avoidable than others; and establish how avoidability varies between different population groups. In a recent systematic review of 34 studies across a number of countries exploring readmissions deemed avoidable, the paucity of robust research in this area with regard to defining avoidability was highlighted, and high variability between studies was reported (5% to 79% of admissions were deemed avoidable). It was concluded that the proportion of potentially avoidable admissions is unknown.3

In the meantime, interventions have been implemented, and performance of health care organisations has been assessed, on the basis of limited understanding of avoidable admission. We need sharper tools than chronic ACSC admissions data — ones that can be used to assess factors associated with individual admissions. Until then, we are in a compromised position in terms of informing policy and program development and measuring the right outcomes.

Authors

  • Jo M Longman1
  • Megan E Passey1
  • Dan P Ewald2
  • 1. University Centre for Rural Health — North Coast, University of Sydney, Lismore, NSW.
  • 2. North Coast NSW Medicare Local, Ballina, NSW.

Correspondence: jo.longman@ucrh.edu.au

Competing interests

No relevant disclosures.

Acknowledgements

We acknowledge the NSW Institute of Rural Clinical Services and Teaching for funding.

References

View this article on Wiley Online Library