Cargando…
Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study
BACKGROUND: Primary health care is subject to regional variation, which may be due to unequal and inefficient distribution of services. One key measure of such variation are potentially avoidable hospitalisations, i.e., hospitalisations for conditions that could have been dealt with in situ by suffi...
Autores principales: | , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380390/ https://www.ncbi.nlm.nih.gov/pubmed/34419031 http://dx.doi.org/10.1186/s12913-021-06876-5 |
_version_ | 1783741188296146944 |
---|---|
author | Gygli, Niklaus Zúñiga, Franziska Simon, Michael |
author_facet | Gygli, Niklaus Zúñiga, Franziska Simon, Michael |
author_sort | Gygli, Niklaus |
collection | PubMed |
description | BACKGROUND: Primary health care is subject to regional variation, which may be due to unequal and inefficient distribution of services. One key measure of such variation are potentially avoidable hospitalisations, i.e., hospitalisations for conditions that could have been dealt with in situ by sufficient primary health care provision. Particularly, potentially avoidable hospitalisations for ambulatory care-sensitive conditions (ACSCs) are a substantial and growing burden for health care systems that require targeting in health care policy. AIMS: Using data from the Swiss Federal Statistical Office (SFSO) from 2017, we applied small area analysis to visualize regional variation to comprehensively map potentially avoidable hospitalisations for five ACSCs from Swiss nursing homes, home care organisations and the general population. METHODS: This retrospective observational study used data on all Swiss hospitalisations in 2017 to assess regional variations of potentially avoidable hospitalisations for angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, diabetes complications and hypertension. We used small areas, utilisation-based hospital service areas (HSAs), and administrative districts (Cantons) as geographic zones. The outcomes of interest were age and sex standardised rates of potentially avoidable hospitalisations for ACSCs in adults (> 15 years). Our inferential analyses used linear mixed models with Gaussian distribution. RESULTS: We identified 46,479 hospitalisations for ACSC, or 4.3% of all hospitalisations. Most of these occurred in the elderly population for congestive heart failure and COPD. The median rate of potentially avoidable hospitalisation for ACSC was 527 (IQR 432–620) per 100.000 inhabitants. We found substantial regional variation for HSAs and administrative districts as well as disease-specific regional patterns. CONCLUSIONS: Differences in continuity of care might be key drivers for regional variation of potentially avoidable hospitalisations for ACSCs. These results provide a new perspective on the functioning of primary care structures in Switzerland and call for novel approaches in effective primary care delivery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06876-5. |
format | Online Article Text |
id | pubmed-8380390 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-83803902021-08-23 Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study Gygli, Niklaus Zúñiga, Franziska Simon, Michael BMC Health Serv Res Research BACKGROUND: Primary health care is subject to regional variation, which may be due to unequal and inefficient distribution of services. One key measure of such variation are potentially avoidable hospitalisations, i.e., hospitalisations for conditions that could have been dealt with in situ by sufficient primary health care provision. Particularly, potentially avoidable hospitalisations for ambulatory care-sensitive conditions (ACSCs) are a substantial and growing burden for health care systems that require targeting in health care policy. AIMS: Using data from the Swiss Federal Statistical Office (SFSO) from 2017, we applied small area analysis to visualize regional variation to comprehensively map potentially avoidable hospitalisations for five ACSCs from Swiss nursing homes, home care organisations and the general population. METHODS: This retrospective observational study used data on all Swiss hospitalisations in 2017 to assess regional variations of potentially avoidable hospitalisations for angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, diabetes complications and hypertension. We used small areas, utilisation-based hospital service areas (HSAs), and administrative districts (Cantons) as geographic zones. The outcomes of interest were age and sex standardised rates of potentially avoidable hospitalisations for ACSCs in adults (> 15 years). Our inferential analyses used linear mixed models with Gaussian distribution. RESULTS: We identified 46,479 hospitalisations for ACSC, or 4.3% of all hospitalisations. Most of these occurred in the elderly population for congestive heart failure and COPD. The median rate of potentially avoidable hospitalisation for ACSC was 527 (IQR 432–620) per 100.000 inhabitants. We found substantial regional variation for HSAs and administrative districts as well as disease-specific regional patterns. CONCLUSIONS: Differences in continuity of care might be key drivers for regional variation of potentially avoidable hospitalisations for ACSCs. These results provide a new perspective on the functioning of primary care structures in Switzerland and call for novel approaches in effective primary care delivery. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06876-5. BioMed Central 2021-08-21 /pmc/articles/PMC8380390/ /pubmed/34419031 http://dx.doi.org/10.1186/s12913-021-06876-5 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Gygli, Niklaus Zúñiga, Franziska Simon, Michael Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title | Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title_full | Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title_fullStr | Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title_full_unstemmed | Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title_short | Regional variation of potentially avoidable hospitalisations in Switzerland: an observational study |
title_sort | regional variation of potentially avoidable hospitalisations in switzerland: an observational study |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380390/ https://www.ncbi.nlm.nih.gov/pubmed/34419031 http://dx.doi.org/10.1186/s12913-021-06876-5 |
work_keys_str_mv | AT gygliniklaus regionalvariationofpotentiallyavoidablehospitalisationsinswitzerlandanobservationalstudy AT zunigafranziska regionalvariationofpotentiallyavoidablehospitalisationsinswitzerlandanobservationalstudy AT simonmichael regionalvariationofpotentiallyavoidablehospitalisationsinswitzerlandanobservationalstudy |