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Title: Preventing unnecessary unplanned hospital admissions and achieving timely discharge; an analysis of geographic variation
Author: Busby, John
ISNI:       0000 0004 6058 0131
Awarding Body: University of Bristol
Current Institution: University of Bristol
Date of Award: 2015
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Background. Reducing unplanned hospital admissions and achieving timely discharge are key issues for healthcare systems worldwide. Policymakers have focussed on admissions for ambulatory care sensitive conditions (ACSCs) as they are potentially avoidable. Exploring geographic variation could identify variable care pathways. Aims. To investigate the magnitude and causes of geographic variation in unplanned ACSC care. To explore key methodological issues pertinent to small-area variation studies and how this data can inform local decisions. Methods. I conducted a systematic review exploring the magnitude and causes of geographic variation. I estimated geographic variation in ACSC admission rates, length of stay and.readmission rates between PCTs and general practices. I investigated what might be driving these differences. I contrasted geographic variation across patient subgroups. I examined how methodological issues impacted the conclusions of small-area variation studies. I explored how benchmarking is used locally. Results. ACSCs are a large and growing problem. Care processes were highly variable for most, although not all, conditions. Admissions for younger patients, or those with low illness severity, were consistently more variable. Areas with greater bed availability, reduced care continuity and increased A&E proximity had consistently higher admission rates. A range of methodologies were used to quantify geographic variation which can impact conclusions and hinder comparisons. Benchmarking is widely used locally however perceptions of poor data reliability sometimes undermined its utility. Conclusions. There are important differences in ACSC care processes across England. Further work is needed to understand the causes of these differences and should initially focus on the most variable conditions and patient subgroups. Several factors are strongly associated with admission rates; where possible the causal effect of these should be tested using more robust study designs. Improvements in the reliability of routinely collected data, and the methodological rigor of small-area variation studies, is needed to improve their utility.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available