ian blunt: focus on preventable admissions

© Nuffield Trust and Health Foundation © Nuffield Trust

23 October 2013

Focus on…

© Nuffield Trust and Health Foundation

Focus on: a series of in-depth reports

Each year the programme will produce a number of in-depth analyses into specific topics in health and social care using a range of methods.

• Accessibility of acute services

• Trends in preventable emergency admissions

• Analysis of patterns of antidepressant prescribing during the recession

• Access to social care for older people

• Changes in quality for people with hip fractures

© Nuffield Trust and Health Foundation © Nuffield Trust

23 October 2013

Focus on preventable admissions

Ian Blunt


A way of categorising “preventable” admissions?

• For certain conditions, the risk of a crisis leading to emergency hospital admission can be reduced by timely and effective self-care, primary or community care

• A subset of these conditions has been identified as potential indicators of how well health services are managing care to avoid the problems that require emergency admissions.

• This technique for quality measurement was developed in the USA in the early 1990s – now in many countries, including NHS Outcomes Framework


Analytical approach

• Hospital Episode Statistics data

from 2001 to 2013

• Valid age, sex and English LSOA

• Victoria State Health Department

list of ACS conditions +

tuberculosis

• Age/sex–specific admission rates

using ONS population estimates

• Deprivation measured by Indices of

Multiple Deprivation 2010


The conditions matter

“ACS” often used as an aggregate term, but no standard definition (Purdy 2009)

Which conditions are included can make a big difference -chronic ACS admissions in Chichester, for example…

0

100

200

300

400

500

600

700

800

2001/0

2

2002/0

3

2003/0

4

2004/0

5

2005/0

6

2006/0

7

2007/0

8

2008/0

9

2009/1

0

2010/1

1

2011/1

2

2012/1

3

Indir

ectly s

tandard

ised r

ate

(IS

R)

per

100,0

00 p

opula

tion

QualityWatch NHS OF 2.3i


The influence of deprivation


Variation in 2012/13


Variation by condition in 2012/13


Large but uneven increases since 2001


Increases swamp reductions…


Change relative to financial constraints


Conclusion

• Importance of understanding rate and trend for each condition at local level

• Deprivation an important factor to consider – but leave much variation unexplained

• Rates of admission for some conditions have reduced, but many more have increased (including some where substantial policy effort has been applied)

• General trends are being maintained, so far…


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23 October 2013

www.qualitywatch.org.uk

ian blunt: focus on preventable admissions

Health & Medicine