Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions? a cross-sectional study in the East of England

Robert Fleetcroft, Antonia Hardcastle, Nicholas Steel, Gill M. Price, Sarah Purdy, Alistair Lipp, Phyo Kyaw Myint, Amanda Howe

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Abstract

Objectives To use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS) list of ambulatory care sensitive conditions (ACSCs).

Design Analysis of unplanned medical admissions randomly identified in secondary care.

Setting Primary care in the East of England.

Participants 20 general practice teams trained to use SEA on unplanned admissions to identify potentially preventable factors.

Interventions SEA of admissions.

Main outcome measures Level of agreement between those admissions identified as potentially preventable by SEA and the NHS ACSC list.

Results 132 (26%) of randomly selected patients with unplanned admissions gave consent and an SEA was performed by their primary practice team. 130 SEA reports had sufficient data for our analysis. Practices concluded that 17 (13%) admissions were potentially preventable. The NHS ACSC list identified 36 admissions (28%) as potentially preventable. There was a low level of agreement between the practices and the NHS list as to which admissions were preventable (kappa=0.253). The ACSC list consisted mainly of respiratory admissions whereas the practice list identified a wider range of cases and identified context-specific factors as important.

Conclusions There was disagreement between the NHS list and practice conclusions of potentially avoidable admissions. The SEAs suggest that the pathway into unplanned admission may be less dependent on the condition than on context-specific factors, and the assumption that unplanned admissions for ACSCs are reasonable indicators of performance for primary care may not be valid.

Original languageEnglish
Article numbere020756
Pages (from-to)1-10
Number of pages10
JournalBMJ Open
Volume8
Issue number4
Early online date28 Apr 2018
DOIs
Publication statusPublished - Apr 2018

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National Health Programs
Ambulatory Care
England
Cross-Sectional Studies
Primary Health Care
Secondary Care
General Practice
Emergencies
Outcome Assessment (Health Care)

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Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions? a cross-sectional study in the East of England. / Fleetcroft, Robert; Hardcastle, Antonia; Steel, Nicholas; Price, Gill M.; Purdy, Sarah; Lipp, Alistair; Myint, Phyo Kyaw; Howe, Amanda.

In: BMJ Open, Vol. 8, No. 4, e020756, 04.2018, p. 1-10.

Research output: Contribution to journalArticle

Fleetcroft, Robert ; Hardcastle, Antonia ; Steel, Nicholas ; Price, Gill M. ; Purdy, Sarah ; Lipp, Alistair ; Myint, Phyo Kyaw ; Howe, Amanda. / Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions? a cross-sectional study in the East of England. In: BMJ Open. 2018 ; Vol. 8, No. 4. pp. 1-10.
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title = "Does practice analysis agree with the ambulatory care sensitive conditions’ list of avoidable unplanned admissions?: a cross-sectional study in the East of England",
abstract = "Objectives To use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS) list of ambulatory care sensitive conditions (ACSCs).Design Analysis of unplanned medical admissions randomly identified in secondary care.Setting Primary care in the East of England.Participants 20 general practice teams trained to use SEA on unplanned admissions to identify potentially preventable factors.Interventions SEA of admissions.Main outcome measures Level of agreement between those admissions identified as potentially preventable by SEA and the NHS ACSC list.Results 132 (26{\%}) of randomly selected patients with unplanned admissions gave consent and an SEA was performed by their primary practice team. 130 SEA reports had sufficient data for our analysis. Practices concluded that 17 (13{\%}) admissions were potentially preventable. The NHS ACSC list identified 36 admissions (28{\%}) as potentially preventable. There was a low level of agreement between the practices and the NHS list as to which admissions were preventable (kappa=0.253). The ACSC list consisted mainly of respiratory admissions whereas the practice list identified a wider range of cases and identified context-specific factors as important.Conclusions There was disagreement between the NHS list and practice conclusions of potentially avoidable admissions. The SEAs suggest that the pathway into unplanned admission may be less dependent on the condition than on context-specific factors, and the assumption that unplanned admissions for ACSCs are reasonable indicators of performance for primary care may not be valid.",
author = "Robert Fleetcroft and Antonia Hardcastle and Nicholas Steel and Price, {Gill M.} and Sarah Purdy and Alistair Lipp and Myint, {Phyo Kyaw} and Amanda Howe",
note = "Acknowledgments We are very grateful to the Norfolk and Suffolk Primary andCommunity Care Research Office, the Sponsor NHS South Norfolk CCG, Public andPatient Involvement in Research (PPIRes) and the two patient representatives,the participating general practices, hospitals and patients for their help with theoriginal study. Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-0212-27059).",
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AU - Fleetcroft, Robert

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AU - Steel, Nicholas

AU - Price, Gill M.

AU - Purdy, Sarah

AU - Lipp, Alistair

AU - Myint, Phyo Kyaw

AU - Howe, Amanda

N1 - Acknowledgments We are very grateful to the Norfolk and Suffolk Primary andCommunity Care Research Office, the Sponsor NHS South Norfolk CCG, Public andPatient Involvement in Research (PPIRes) and the two patient representatives,the participating general practices, hospitals and patients for their help with theoriginal study. Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (grant reference number PB-PG-0212-27059).

PY - 2018/4

Y1 - 2018/4

N2 - Objectives To use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS) list of ambulatory care sensitive conditions (ACSCs).Design Analysis of unplanned medical admissions randomly identified in secondary care.Setting Primary care in the East of England.Participants 20 general practice teams trained to use SEA on unplanned admissions to identify potentially preventable factors.Interventions SEA of admissions.Main outcome measures Level of agreement between those admissions identified as potentially preventable by SEA and the NHS ACSC list.Results 132 (26%) of randomly selected patients with unplanned admissions gave consent and an SEA was performed by their primary practice team. 130 SEA reports had sufficient data for our analysis. Practices concluded that 17 (13%) admissions were potentially preventable. The NHS ACSC list identified 36 admissions (28%) as potentially preventable. There was a low level of agreement between the practices and the NHS list as to which admissions were preventable (kappa=0.253). The ACSC list consisted mainly of respiratory admissions whereas the practice list identified a wider range of cases and identified context-specific factors as important.Conclusions There was disagreement between the NHS list and practice conclusions of potentially avoidable admissions. The SEAs suggest that the pathway into unplanned admission may be less dependent on the condition than on context-specific factors, and the assumption that unplanned admissions for ACSCs are reasonable indicators of performance for primary care may not be valid.

AB - Objectives To use significant event audits (SEAs) in primary care to determine which of a sample of emergency (unplanned) admissions were potentially avoidable; and compare with the National Health Service (NHS) list of ambulatory care sensitive conditions (ACSCs).Design Analysis of unplanned medical admissions randomly identified in secondary care.Setting Primary care in the East of England.Participants 20 general practice teams trained to use SEA on unplanned admissions to identify potentially preventable factors.Interventions SEA of admissions.Main outcome measures Level of agreement between those admissions identified as potentially preventable by SEA and the NHS ACSC list.Results 132 (26%) of randomly selected patients with unplanned admissions gave consent and an SEA was performed by their primary practice team. 130 SEA reports had sufficient data for our analysis. Practices concluded that 17 (13%) admissions were potentially preventable. The NHS ACSC list identified 36 admissions (28%) as potentially preventable. There was a low level of agreement between the practices and the NHS list as to which admissions were preventable (kappa=0.253). The ACSC list consisted mainly of respiratory admissions whereas the practice list identified a wider range of cases and identified context-specific factors as important.Conclusions There was disagreement between the NHS list and practice conclusions of potentially avoidable admissions. The SEAs suggest that the pathway into unplanned admission may be less dependent on the condition than on context-specific factors, and the assumption that unplanned admissions for ACSCs are reasonable indicators of performance for primary care may not be valid.

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DO - 10.1136/bmjopen-2017-020756

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JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

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