GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients
Abstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified AS...
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| Format: | Article |
| Language: | English |
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BMC
2020-10-01
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| Series: | BMC Family Practice |
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| Online Access: | http://link.springer.com/article/10.1186/s12875-020-01285-9 |
| _version_ | 1817978176288063488 |
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| author | Leah Palapar Laura Wilkinson-Meyers Thomas Lumley Ngaire Kerse |
| author_facet | Leah Palapar Laura Wilkinson-Meyers Thomas Lumley Ngaire Kerse |
| author_sort | Leah Palapar |
| collection | DOAJ |
| description | Abstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224 . |
| first_indexed | 2024-04-13T22:26:46Z |
| format | Article |
| id | doaj.art-6809941962264ad8ac4465b436ea4f7e |
| institution | Directory Open Access Journal |
| issn | 1471-2296 |
| language | English |
| last_indexed | 2024-04-13T22:26:46Z |
| publishDate | 2020-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Family Practice |
| spelling | doaj.art-6809941962264ad8ac4465b436ea4f7e2022-12-22T02:27:03ZengBMCBMC Family Practice1471-22962020-10-0121111210.1186/s12875-020-01285-9GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patientsLeah Palapar0Laura Wilkinson-Meyers1Thomas Lumley2Ngaire Kerse3Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandHealth Systems Section, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandDepartment of Statistics, Faculty of Science, University of AucklandDepartment of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of AucklandAbstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224 .http://link.springer.com/article/10.1186/s12875-020-01285-9Primary care practice variationPhysician variationHospitalisationsOlder people |
| spellingShingle | Leah Palapar Laura Wilkinson-Meyers Thomas Lumley Ngaire Kerse GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients BMC Family Practice Primary care practice variation Physician variation Hospitalisations Older people |
| title | GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients |
| title_full | GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients |
| title_fullStr | GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients |
| title_full_unstemmed | GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients |
| title_short | GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients |
| title_sort | gp and practice related variation in ambulatory sensitive hospitalisations of older primary care patients |
| topic | Primary care practice variation Physician variation Hospitalisations Older people |
| url | http://link.springer.com/article/10.1186/s12875-020-01285-9 |
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