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Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia

BACKGROUND: Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. OBJECTIVE...

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Autores principales: Falster, Michael O., Jorm, Louisa R., Douglas, Kirsty A., Blyth, Fiona M., Elliott, Robert F., Leyland, Alastair H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396734/
https://www.ncbi.nlm.nih.gov/pubmed/25793270
http://dx.doi.org/10.1097/MLR.0000000000000342
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author Falster, Michael O.
Jorm, Louisa R.
Douglas, Kirsty A.
Blyth, Fiona M.
Elliott, Robert F.
Leyland, Alastair H.
author_facet Falster, Michael O.
Jorm, Louisa R.
Douglas, Kirsty A.
Blyth, Fiona M.
Elliott, Robert F.
Leyland, Alastair H.
author_sort Falster, Michael O.
collection PubMed
description BACKGROUND: Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. OBJECTIVE: To quantify the relative contributions of the supply of general practitioners (GPs) and personal sociodemographic and health characteristics, to geographic variation in preventable hospitalization. METHODS: Self-reported questionnaire data for 267,091 participants in the 45 and Up Study, Australia, were linked with administrative hospital data to identify preventable hospitalizations. Multilevel Poisson models, with participants clustered in their geographic area of residence, were used to explore factors that explain geographic variation in hospitalization. RESULTS: GP supply, measured as full-time workload equivalents, was not a significant predictor of preventable hospitalization, and explained only a small amount (2.9%) of the geographic variation in hospitalization rates. Conversely, more than one-third (36.9%) of variation was driven by the sociodemographic composition, health, and behaviors of the population. These personal characteristics explained a greater amount of the variation for chronic conditions (37.5%) than acute (15.5%) or vaccine-preventable conditions (2.4%). CONCLUSIONS: Personal sociodemographic and health characteristics, rather than GP supply, are major drivers of preventable hospitalization. Their contribution varies according to condition, and if used for performance comparison purposes, geographic rates of preventable hospitalization should be reported according to individual condition or potential pathways for intervention.
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spelling pubmed-43967342015-04-22 Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia Falster, Michael O. Jorm, Louisa R. Douglas, Kirsty A. Blyth, Fiona M. Elliott, Robert F. Leyland, Alastair H. Med Care Original Articles BACKGROUND: Geographic rates of preventable hospitalization are used internationally as an indicator of accessibility and quality of primary care. Much research has correlated the indicator with the supply of primary care services, yet multiple other factors may influence these admissions. OBJECTIVE: To quantify the relative contributions of the supply of general practitioners (GPs) and personal sociodemographic and health characteristics, to geographic variation in preventable hospitalization. METHODS: Self-reported questionnaire data for 267,091 participants in the 45 and Up Study, Australia, were linked with administrative hospital data to identify preventable hospitalizations. Multilevel Poisson models, with participants clustered in their geographic area of residence, were used to explore factors that explain geographic variation in hospitalization. RESULTS: GP supply, measured as full-time workload equivalents, was not a significant predictor of preventable hospitalization, and explained only a small amount (2.9%) of the geographic variation in hospitalization rates. Conversely, more than one-third (36.9%) of variation was driven by the sociodemographic composition, health, and behaviors of the population. These personal characteristics explained a greater amount of the variation for chronic conditions (37.5%) than acute (15.5%) or vaccine-preventable conditions (2.4%). CONCLUSIONS: Personal sociodemographic and health characteristics, rather than GP supply, are major drivers of preventable hospitalization. Their contribution varies according to condition, and if used for performance comparison purposes, geographic rates of preventable hospitalization should be reported according to individual condition or potential pathways for intervention. Lippincott Williams & Wilkins 2015-05 2015-04-23 /pmc/articles/PMC4396734/ /pubmed/25793270 http://dx.doi.org/10.1097/MLR.0000000000000342 Text en Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.
spellingShingle Original Articles
Falster, Michael O.
Jorm, Louisa R.
Douglas, Kirsty A.
Blyth, Fiona M.
Elliott, Robert F.
Leyland, Alastair H.
Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title_full Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title_fullStr Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title_full_unstemmed Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title_short Sociodemographic and Health Characteristics, Rather Than Primary Care Supply, are Major Drivers of Geographic Variation in Preventable Hospitalizations in Australia
title_sort sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in australia
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396734/
https://www.ncbi.nlm.nih.gov/pubmed/25793270
http://dx.doi.org/10.1097/MLR.0000000000000342
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