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 (Lead / Corresponding author), Damilola Olajide, Mark Dusheiko, Robert Elliott, Bruce Guthrie, Louisa Jorm, Alastair H. Leyland

    Research output: Contribution to journalArticle

    1 Citation (Scopus)
    42 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
    Pages (from-to)1-10
    Number of pages10
    JournalBMC Family Practice
    Volume20
    Issue number1
    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

    Cite this

    van der Pol, Marjon ; Olajide, Damilola ; Dusheiko, Mark ; Elliott, Robert ; Guthrie, Bruce ; Jorm, Louisa ; Leyland, Alastair H. / 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. In: BMC Family Practice. 2019 ; Vol. 20, No. 1. pp. 1-10.
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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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    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 (Lead / Corresponding author); Olajide, Damilola; Dusheiko, Mark; Elliott, Robert; Guthrie, Bruce; Jorm, Louisa; Leyland, Alastair H.

    In: BMC Family Practice, Vol. 20, No. 1, 32, 22.02.2019, p. 1-10.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland

    T2 - longitudinal analysis

    AU - van der Pol, Marjon

    AU - Olajide, Damilola

    AU - Dusheiko, Mark

    AU - Elliott, Robert

    AU - Guthrie, Bruce

    AU - Jorm, Louisa

    AU - Leyland, Alastair H.

    PY - 2019/2/22

    Y1 - 2019/2/22

    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.

    KW - Emergency admissions

    KW - Primary care

    KW - Ambulatory care sensitive conditions

    U2 - 10.1186/s12875-019-0921-z

    DO - 10.1186/s12875-019-0921-z

    M3 - Article

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    SP - 1

    EP - 10

    JO - BMC Family Practice

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    SN - 1471-2296

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    ER -