The impact of quality and accessibility of primary care on emergency admissions for a range of chronic Ambulatory Care Sensitive Conditions (ACSCs) in Scotland

longitudinal analysis

Marjon Van der Pol (Corresponding Author), Damilola Olajide, Mark Dusheiko, Robert Elliott, Bruce Guthrie, Louisa Jorm, Alastair H. Leyland

Research output: Contribution to journalArticle

1 Citation (Scopus)
4 Downloads (Pure)

Abstract

Background: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.
Methods: Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.
Results: We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.
Conclusions: The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.
Original languageEnglish
Article number32
JournalBMC Family Practice
Volume20
DOIs
Publication statusPublished - 22 Feb 2019

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Scotland
Ambulatory Care
Primary Health Care
Emergencies
Quality of Health Care
Statistical Models
Population Characteristics
Disease Management
General Practice

Keywords

  • emergency admissions
  • primary care
  • Ambulatory Care Sensitive Conditions
  • Ambulatory care sensitive conditions
  • Emergency admissions
  • Primary care

ASJC Scopus subject areas

  • Family Practice

Cite this

The impact of quality and accessibility of primary care on emergency admissions for a range of chronic Ambulatory Care Sensitive Conditions (ACSCs) in Scotland : longitudinal analysis. / Van der Pol, Marjon (Corresponding Author); Olajide, Damilola; Dusheiko, Mark; Elliott, Robert; Guthrie, Bruce; Jorm, Louisa; Leyland, Alastair H.

In: BMC Family Practice, Vol. 20, 32, 22.02.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.Methods: Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.Results: We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.Conclusions: The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.",
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note = "Funding This research was funded by the Chief Scientist Office (grant CZH/4/916). Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorate. AL is funded by the Medical Research Council (MC_UU_12017/13) and the Chief Scientist Office of the Scottish Government Health Directorate (SPHSU13)",
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AU - Dusheiko, Mark

AU - Elliott, Robert

AU - Guthrie, Bruce

AU - Jorm, Louisa

AU - Leyland, Alastair H.

N1 - Funding This research was funded by the Chief Scientist Office (grant CZH/4/916). Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Government Health Directorate. AL is funded by the Medical Research Council (MC_UU_12017/13) and the Chief Scientist Office of the Scottish Government Health Directorate (SPHSU13)

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N2 - Background: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.Methods: Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.Results: We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.Conclusions: The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.

AB - Background: Hospital admissions for Ambulatory Care Sensitive Conditions (ACSC) are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used as performance indicators. However, key questions remain about the validity of these measures. The evidence to date has been inconclusive and limited to specific conditions. The aim of this study was to test the robustness of ACSC admissions as indicators of the quality of primary care. It is the first study to examine a wide range of ACSCs using longitudinal data which enables us to control for unmeasured characteristics which differ by practice but which are constant over time.Methods: Using longitudinal data at the practice level, from 907 Scottish practices for the time period 1/4/2005 to 31/32012, we explored the relationships between the quality of primary care, and hospital admissions for multiple ACSCs controlling for a wide range of covariates including characteristics of GP practices, characteristics of the practice population, hospital effects and year effects. We examined the impact of two dimensions of quality of care: clinical quality of and access to daytime general practice. Generalised Estimating Equations taking the form of Negative Binomial regression models with the practice population included as the exposure term were estimated.Results: We found that higher achievement on some clinical quality measures of primary care was associated with reduced ACSC emergency admissions. We also show that access to primary care was associated with ACSC emergency admissions. However, the effects were small and inconsistent and ACSC emergency admissions were associated with several confounding factors such as deprivation, rurality and distance to the hospital.Conclusions: The results suggest caution in the use of crude ACSC admission rates as a performance indicator of quality of primary care.

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