Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews
Objectives The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland.Design Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-09-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/13/9/e072734.full |
| _version_ | 1797668105272426496 |
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| author | Lorna Aucott Pat Hoddinott Philip Wilson Stephen Turner Richard G Kyle Emma King Smita Dick Emma France Cari Malcolm |
| author_facet | Lorna Aucott Pat Hoddinott Philip Wilson Stephen Turner Richard G Kyle Emma King Smita Dick Emma France Cari Malcolm |
| author_sort | Lorna Aucott |
| collection | DOAJ |
| description | Objectives The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland.Design Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital were compared across the 11 regions. Five diverse regions with different SSA per capita formed cases for qualitative interviews with health professionals and parents to explore how care pathways, service features and geography may influence decisions to admit.Setting Scotland.Participants All children admitted to hospital 2015–2017. Healthcare staff (n=48) and parents (n=15) were interviewed.Results Of 171 039 urgent hospital admissions, 92 229 were SSAs, with a fivefold variation between 14 and 69/1000 children/year across regions. SSAs were higher for children in the most deprived compared with the least deprived communities. When expressed as a ratio of highest to lowest SSA/1000 children/year for diagnosed conditions between regions, the ratio was highest (10.1) for upper respiratory tract infection and lowest (2.8) for convulsions. Readmissions varied between 0.80 and 2.52/1000/year, with regions reporting higher SSA rates more likely to report higher readmission rates (r=0.70, p=0.016, n=11). Proximity and ease of access to services, local differences in service structure and configuration, national policy directives and disparities in how an SSA is defined were recognised by interviewees as explaining the observed regional variations in SSAs. Socioeconomic deprivation was seldom spontaneously raised by professionals when reflecting on reasons to refer or admit a child. Instead, greater emphasis was placed on the wider social circumstances and parents’ capacity to cope with and manage their child’s illness at home.Conclusion SSA rates for children vary quantitatively by region, condition and area deprivation and our interviews identify reasons for this. These findings can usefully inform future care pathway interventions. |
| first_indexed | 2024-03-11T20:24:13Z |
| format | Article |
| id | doaj.art-5d063cbc125c45f9b1e3048a52451303 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-03-11T20:24:13Z |
| publishDate | 2023-09-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-5d063cbc125c45f9b1e3048a524513032023-10-02T22:10:08ZengBMJ Publishing GroupBMJ Open2044-60552023-09-0113910.1136/bmjopen-2023-072734Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviewsLorna Aucott0Pat Hoddinott1Philip Wilson2Stephen Turner3Richard G Kyle4Emma King5Smita Dick6Emma France7Cari Malcolm8Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UKNursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UKInstitute of Health and Wellbeing, University of Aberdeen, Aberdeen, UK1 Edinburgh Dental Institute and Division of Medical and Radiological Sciences, University of Edinburgh, Edinburgh, UKAcademy of Nursing, University of Exeter, Exeter, UKNursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UKDepartment of Child Health, University of Aberdeen, Aberdeen, UKNursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UKSchool of Health Science, University of Dundee, Dundee, UKObjectives The aim of this sequential mixed-methods study was to describe and understand how paediatric short stay admission (SSA) rates vary across Health Board regions of Scotland.Design Exploratory sequential mixed-methods study. Routinely acquired data for the annual (per capita) SSA to hospital were compared across the 11 regions. Five diverse regions with different SSA per capita formed cases for qualitative interviews with health professionals and parents to explore how care pathways, service features and geography may influence decisions to admit.Setting Scotland.Participants All children admitted to hospital 2015–2017. Healthcare staff (n=48) and parents (n=15) were interviewed.Results Of 171 039 urgent hospital admissions, 92 229 were SSAs, with a fivefold variation between 14 and 69/1000 children/year across regions. SSAs were higher for children in the most deprived compared with the least deprived communities. When expressed as a ratio of highest to lowest SSA/1000 children/year for diagnosed conditions between regions, the ratio was highest (10.1) for upper respiratory tract infection and lowest (2.8) for convulsions. Readmissions varied between 0.80 and 2.52/1000/year, with regions reporting higher SSA rates more likely to report higher readmission rates (r=0.70, p=0.016, n=11). Proximity and ease of access to services, local differences in service structure and configuration, national policy directives and disparities in how an SSA is defined were recognised by interviewees as explaining the observed regional variations in SSAs. Socioeconomic deprivation was seldom spontaneously raised by professionals when reflecting on reasons to refer or admit a child. Instead, greater emphasis was placed on the wider social circumstances and parents’ capacity to cope with and manage their child’s illness at home.Conclusion SSA rates for children vary quantitatively by region, condition and area deprivation and our interviews identify reasons for this. These findings can usefully inform future care pathway interventions.https://bmjopen.bmj.com/content/13/9/e072734.full |
| spellingShingle | Lorna Aucott Pat Hoddinott Philip Wilson Stephen Turner Richard G Kyle Emma King Smita Dick Emma France Cari Malcolm Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews BMJ Open |
| title | Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews |
| title_full | Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews |
| title_fullStr | Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews |
| title_full_unstemmed | Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews |
| title_short | Regional variations in short stay urgent paediatric hospital admissions: a sequential mixed-methods approach exploring differences through data linkage and qualitative interviews |
| title_sort | regional variations in short stay urgent paediatric hospital admissions a sequential mixed methods approach exploring differences through data linkage and qualitative interviews |
| url | https://bmjopen.bmj.com/content/13/9/e072734.full |
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