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; Damilola Olajide; Mark Dusheiko; Robert Elliott; Bruce Guthrie; Louisa Jorm; Alastair H. Leyland

doi:10.1186/s12875-019-0921-z

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

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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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.

Original language	English
Article number	32
Journal	BMC Family Practice
Volume	20
DOIs	https://doi.org/10.1186/s12875-019-0921-z
Publication status	Published - 22 Feb 2019

Bibliographical 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)

Keywords

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

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10.1186/s12875-019-0921-zLicence: CC BY

The impact of quality and accessibility of primary care
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Final published version, 891 KBLicence: CC BY

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

Research output: Contribution to journal › Article › peer-review

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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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AU - Guthrie, Bruce

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AU - Leyland, Alastair H.

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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.

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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

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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

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Bibliographical note

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