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Iashchenko I, Flemming R, Franke S, Sundmacher L. Do physician networks with standardized audit and feedback deliver better quality care for older patients compared to regular care?: a quasi-experimental study using claims data from Bavaria, Germany. Eur J Public Health 2023; 33:981-986. [PMID: 37563087 PMCID: PMC10710359 DOI: 10.1093/eurpub/ckad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Physician networks (PNs) are a recent development in Germany, designed to improve the coordination and quality of healthcare. We compared the performance of PNs that use a standardized system of audit and feedback to that of regular care. METHODS We analysed a large sample of claims data from Bavaria, Germany, using nearest-neighbour propensity score matching. Patients who had ambulatory care-sensitive conditions (ACSCs) and were enrolled in PNs were matched with control patients receiving regular care. We examined potentially avoidable hospitalizations related to the 13 most common ACSCs (primary endpoints), as well as processes-of-care indicators for disease prevention, pharmacotherapy and coordination of care. RESULTS There were no significant differences in rates of potentially avoidable hospitalizations between the two groups. However, the networks showed higher vaccination rates, increased participation in disease management programmes, and more frequent use of referrals when consulting specialist physicians. On average, network patients visited a greater number of specialists and had lower continuity of care compared to patients receiving regular care. Polypharmacy and PRISCUS-list prescriptions were more prevalent in the networks. CONCLUSIONS PNs using audit and feedback do not appear to perform better than regular care in preventing hospitalizations due to ACSCs. However, they do perform better in disease prevention measures while showing inconclusive results for care coordination and pharmacotherapy. Further research is needed to understand effective collaboration among providers and its impact on the quality of care within PNs.
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Affiliation(s)
- Iryna Iashchenko
- Department of Sport and Health Sciences, Technical University of Munich, Munich 80992, Germany
| | - Ronja Flemming
- Department of Sport and Health Sciences, Technical University of Munich, Munich 80992, Germany
| | - Sebastian Franke
- Department of Sport and Health Sciences, Technical University of Munich, Munich 80992, Germany
| | - Leonie Sundmacher
- Department of Sport and Health Sciences, Technical University of Munich, Munich 80992, Germany
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Satokangas M, Arffman M, Agerholm J, Thielen K, Hougaard CØ, Andersen I, Burström B, Keskimäki I. Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000-2015. BMC Health Serv Res 2023; 23:835. [PMID: 37550672 PMCID: PMC10405465 DOI: 10.1186/s12913-023-09855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000-2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. METHODS We acquired individual level ACSCs for those aged ≥ 45 in 2000-2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45-64, 65-75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. RESULTS Copenhagen had the highest IRR of ACSCs among those aged 45-64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) - with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. CONCLUSIONS While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
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Affiliation(s)
- Markku Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Martti Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ørsted Hougaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, 33014, Tampere, Finland
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Allegri C, Banks H, Devillanova C. Avoidable hospitalizations and access to primary care: comparisons among Italians, resident immigrants and undocumented immigrants in administrative hospital discharge records. EClinicalMedicine 2022; 46:101345. [PMID: 35295899 PMCID: PMC8918838 DOI: 10.1016/j.eclinm.2022.101345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Immigrants face multiple barriers in accessing healthcare; however, empirical assessment of access presents serious methodological issues, and evidence on undocumented immigrants is scant and based mainly on non-representative samples. We examine avoidable hospitalization (AH) as an indicator of poor access to primary care (PC) in Italy, where a universal healthcare system guarantees access but fails to assign general practitioners to undocumented immigrants. METHODS Using anonymized national hospital discharge records in 2019, undocumented immigrants were identified through an administrative financing code. Potential effects of poor access to PC were measured by focusing on the incidence of AH, differentiated among chronic, acute and vaccine-preventable conditions, comparing Italian citizens, documented (foreign nationals with residence permits) and undocumented immigrants. We estimated odd ratios (ORs) through logistic regression models, controlling for individual and contextual confounders. FINDINGS Compared with Italians, undocumented and documented immigrants adjusted odd ratios (OR) for the risk of AH were 1·422 (95% CI 1·322-1·528) and 1·243 (95% CI 1·201-1·287), respectively. Documented immigrants showed ORs not significantly greater than 1 for AH due to chronic diseases compared with Italians, while undocumented immigrants registered higher adjusted OR for all AH categories - chronic (OR 1·187; 95% CI 1·064-1·325), acute (OR 1·645; 95% CI 1·500-1·803) and vaccine-preventable (OR 2·170; 95% CI 1·285-3·664). INTERPRETATION Documented and undocumented immigrants face considerably higher risk of AH compared to Italians. Considering the burden of AHs, access to PC (including preventive and ambulatory care) should be provided to undocumented immigrants, and additional barriers to care for all immigrants should be further explored. FUNDING None.
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Affiliation(s)
- Chiara Allegri
- Department of Social and Political Sciences, Bocconi University
| | - Helen Banks
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Bocconi University
| | - Carlo Devillanova
- Department of Social and Political Sciences, Bocconi University, Dondena, CReAM, and Fondazione Roberto Franceschi
- Corresponding author.
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Rocha JVM, Santana R, Tello JE. Hospitalization for ambulatory care sensitive conditions: What conditions make inter-country comparisons possible? HEALTH POLICY OPEN 2021; 2:100030. [PMID: 37383514 PMCID: PMC10297774 DOI: 10.1016/j.hpopen.2021.100030] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 11/23/2020] [Accepted: 12/30/2020] [Indexed: 11/20/2022] Open
Abstract
Hospitalizations for ambulatory care sensitive conditions have been extensively used in health services research to assess access, quality and performance of primary health care. Inter-country comparisons can assist policy-makers in pursuing better health outcomes by contrasting policy design, implementation and evaluation. The objective of this study is to identify the conceptual, methodological, contextual and policy dimensions and factors that need to be accounted for when comparing these types of hospitalizations across countries. A conceptual framework for inter-country comparisons was drawn based on a review of 18 studies with inter-country comparison of ambulatory care sensitive conditions hospitalizations. The dimensions include methodological choices; population's demographic, epidemiologic and socio-economic profiles and features of the health services and system. Main factors include access and quality of primary health care, availability of health workforce and health facilities, health interventions and inequalities. The proposed framework can assist in designing studies and interpreting findings of inter-country comparisons of ambulatory care sensitive conditions hospitalizations, accelerating learning and progress towards universal health coverage.
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Affiliation(s)
- João Victor Muniz Rocha
- Escola Nacional de Saúde Pública, Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Portugal
| | - Rui Santana
- Escola Nacional de Saúde Pública, Comprehensive Health Research Centre, Universidade NOVA de Lisboa, Portugal
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Pinto A, Santos JV, Souza J, Viana J, Costa Santos C, Lobo M, Freitas A. Comparison and Impact of Four Different Methodologies for Identification of Ambulatory Care Sensitive Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8121. [PMID: 33153171 PMCID: PMC7662634 DOI: 10.3390/ijerph17218121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/30/2022]
Abstract
Ambulatory care sensitive conditions (ACSCs) are conditions for which hospitalizations are thought to be avoidable if effective and accessible primary health care is available. However, to define which conditions are considered ACSCs, there is a considerable number of different lists. Our aim was to compare the impact of using different ACSC lists considering mainland Portugal hospitalizations. A retrospective study with inpatient data from Portuguese public hospital discharges between 2011 and 2015 was conducted. Four ACSC list sources were considered: Agency for Healthcare Research and Quality (AHRQ), Canadian Institute for Health Information (CIHI), the Victorian Ambulatory Care Sensitive Conditions study, and Sarmento et al. Age-sex-adjusted rates of ACSCs were calculated by district (hospitalizations per 100,000 inhabitants). Spearman's rho, the intraclass correlation coefficient (ICC), the information-based measure of disagreement (IBMD), and Bland and Altman plots were computed. Results showed that by applying the four lists, different age-sex-adjusted rates are obtained. However, the lists that seemed to demonstrate greater agreement and consistency were the list proposed by Sarmento et al. compared to AHRQ and the AHRQ method compared to the Victorian list. It is important to state that we should compare comparable indicators and ACSC lists cannot be used interchangeably.
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Affiliation(s)
- Andreia Pinto
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Vasco Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
- Public Health Unit, ACES Grande Porto VIII–Espinho/Gaia, 4500-330 Porto, Portugal
| | - Júlio Souza
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - João Viana
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Cristina Costa Santos
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Mariana Lobo
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
| | - Alberto Freitas
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal; (J.V.S.); (J.S.); (J.V.); (C.C.S.); (M.L.); (A.F.)
- CINTESIS–Center for Health Technology and Services Research, 4200-450 Porto, Portugal
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Pollmanns J, Drösler SE, Geraedts M, Weyermann M. Predictors of hospitalizations for diabetes in Germany: an ecological study on a small-area scale. Public Health 2019; 177:112-119. [PMID: 31561049 DOI: 10.1016/j.puhe.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 06/26/2019] [Accepted: 08/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Our objective was to evaluate the role of potential predictors in explaining spatial variation among diabetes hospitalization rates in Germany. STUDY DESIGN This was an ecological analysis using hospital routine data. METHODS County-level hospitalization rates (n = 402) in 2015 were calculated based on the German Diagnosis Related Groups database. We used a funnel plot to identify counties with high hospitalization rates. To examine the impact of predictors such as socio-economic status or structure of primary care, we performed linear and logistic regression analyses. RESULTS The crude hospitalization rate was 262 admissions per 100,000 population. In multivariable logistic models, we found the percentage of employees with academic degree (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.56-0.91), high hospital bed rate (4th quartile vs 1st quartile; OR: 2.73, CI: 1.03-7.24), and diabetes prevalence (OR: 1.49, CI: 1.17-1.90) to be significant predictors for high hospitalization rates. In multivariable linear models, the percentage of unemployed (regression coefficient b: 4.79, CI: 0.81-8.78) and rurality (b: 0.52, CI: 0.19-0.85) explained the variation in addition to predictors from logistic regression. Primary care structure was not a significant predictor in multivariable models. CONCLUSIONS The non-significant impact of primary care in adjusted models casts the use of diabetes hospitalizations as indicators for access and quality of primary care into doubt. Diabetes hospitalizations may rather reflect demand for care.
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Affiliation(s)
- J Pollmanns
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany; Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
| | - S E Drösler
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany.
| | - M Geraedts
- Philipps-Universität Marburg, Department of Medicine, Karl-von-Frisch-Strasse 4, 35043 Marburg, Germany; Universität Witten/Herdecke, Fakultät für Gesundheit, Institut für Gesundheitssystemforschung, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany.
| | - M Weyermann
- Niederrhein University of Applied Sciences, Faculty of Health Care, Reinarzstrasse 49, 47805 Krefeld, Germany.
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Rocha JVM, Sarmento J, Moita B, Marques AP, Santana R. Comparative research aspects on hospitalizations for ambulatory care sensitive conditions: the case of Brazil and Portugal. CIENCIA & SAUDE COLETIVA 2019; 25:1375-1388. [PMID: 32267439 DOI: 10.1590/1413-81232020254.13502019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/23/2019] [Indexed: 11/22/2022] Open
Abstract
Hospitalizations for ambulatory care sensitive conditions have been used to measure access, quality and performance of the primary health care delivery system, as timely and adequate care could potentially avoid the need of hospitalization. Comparative research provides the opportunity for cross-country learning process. Brazil and Portugal have reformed their primary health care services in the last years, with similar organizational characteristics. We used hospitalization data of Brazil and Portugal for the year 2015 to compare hospitalizations for ambulatory care sensitive conditions between the two countries, and discussed conceptual and methodological aspects to be taken into consideration in the comparative approach. Brazil and Portugal presented similarities in causes and standardized rates of hospitalizations for ambulatory care sensitive conditions. There was great sensitivity on rates according to the methodology employed to define conditions. Hospitalizations for ambulatory care sensitive conditions are important sources of pressure for both Brazil and Portugal, and there are conceptual and methodological aspects that are critical to render the country-comparison approach useful.
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Affiliation(s)
- João Victor Muniz Rocha
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - João Sarmento
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Bruno Moita
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Ana Patrícia Marques
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
| | - Rui Santana
- National School of Public Health, NOVA University of Lisbon. Av. Padre Cruz, 1600-560. Lisbon Portugal.
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Pollmanns J, Weyermann M, Geraedts M, Drösler SE. [Hospitalizations and amputations for diabetes mellitus-trends and small-area variation in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:1462-1471. [PMID: 30191270 DOI: 10.1007/s00103-018-2812-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators. OBJECTIVES The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations. MATERIALS AND METHODS Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates. RESULTS Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high. CONCLUSIONS A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.
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Affiliation(s)
- Johannes Pollmanns
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland.
| | - Maria Weyermann
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Philipps-Universität Marburg, Marburg, Deutschland
| | - Saskia E Drösler
- Fachbereich Gesundheitswesen, Hochschule Niederrhein, Reinarzstraße 49, 47805, Krefeld, Deutschland
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Rocha JVM, Nunes C, Santana R. Avoidable hospitalizations in Brazil and Portugal: Identifying and comparing critical areas through spatial analysis. PLoS One 2019; 14:e0219262. [PMID: 31299045 PMCID: PMC6625697 DOI: 10.1371/journal.pone.0219262] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/19/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hospitalizations for ambulatory care sensitive conditions have been used to assess the performance of primary health care. Few studies have compared geographic variation in rates of avoidable hospitalizations and characteristics of high-risk areas within and between countries. The aim of this study was to identify and compare critical areas of avoidable hospitalizations in Brazil and Portugal, because these countries have reformed their primary health care systems in recent years and have similar organizational characteristics. METHODS An ecological study on hospitalizations for ambulatory care sensitive conditions produced in Brazil and Portugal in 2015 was used. Geographic variation of rates were analyzed and compared at the municipal level. A spatial scan statistic was employed to identify clusters with higher risk of hospitalizations for acute and chronic conditions in each country separately. Socioeconomic and primary health care characteristics of critical areas were compared to non-critical areas. RESULTS There were high variations in rates of avoidable hospitalizations within and between Brazil and Portugal, with higher variations found in Brazil. A more evident pattern of rates was found in Portugal. Rates and cluster distribution of acute and chronic conditions had significant agreement for both countries. The differences in primary health care and socioeconomic characteristics between areas identified as high risk clusters and non-clusters varied between category of conditions and between countries. CONCLUSION Brazil and Portugal presented expressive regional differences with respect to rates of avoidable hospitalizations, indicating that there is room to improve by reducing such events in both countries. Different areas presented distinct interactions between primary health care, socioeconomic characteristics, and avoidable hospitalizations. Results indicate that the primary health care reforms, with similar organizational characteristics in different contexts, did not produce similar results either between or within countries. Possible actions to reduce these events should be defined at a local level.
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Affiliation(s)
- João Victor Muniz Rocha
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Carla Nunes
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Rui Santana
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
- Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa, Lisbon, Portugal
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Kim H, Cheng SH. Assessing quality of primary diabetes care in South Korea and Taiwan using avoidable hospitalizations. Health Policy 2018; 122:1222-1231. [PMID: 30274936 DOI: 10.1016/j.healthpol.2018.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 12/01/2022]
Abstract
Quality of primary diabetes care is a key health policy concern in many OECD countries with an aging population. This cross-national, population-based study examined the extent and attributes of diabetes-related avoidable hospitalizations (DRAHs) in South Korea and Taiwan, both of which have social health insurance-based health systems with limited gate-keeping for hospitalizations. We analyzed comparable, nationally representative health insurance beneficiary datasets for the two countries (2002-2013), linked with community health resource data. The age- and sex-standardized DRAH rates were calculated, and multivariate, multi-level longitudinal modeling approaches were adopted. The DRAH rate decreased in Taiwan consistently during 2002-2013 and in Korea after 2011 only. Under the universal health coverage, people enjoyed high accessibility to care. A higher number of physician visits reduced DRAHs in Korea but not in Taiwan. Socio-economic disparities in DRAHs still existed in both countries, especially in Taiwan. We found a different trajectory in two similar health systems for the selected health system performance indicator for primary diabetes care. This can be partly explained by different policy approaches to diabetes management in the two countries over the years. Necessary are policy efforts to improve the quality and equality of primary diabetes care and better control of hospital admissions in these two health systems that provide generous access to care at a low cost in East Asia.
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Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Dept. of Public Health Sciences, Institute of Aging, Institute of Health and Environment at Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, South Korea.
| | - Shou-Hsia Cheng
- College of Public Health Institute of Health Policy and Management and the Population Health Research Center at National Taiwan University, 17, Xu-Zhou Road, Taipei, Taiwan.
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Laberge M, Wodchis WP, Barnsley J, Laporte A. Hospitalizations for ambulatory care sensitive conditions across primary care models in Ontario, Canada. Soc Sci Med 2017; 181:24-33. [DOI: 10.1016/j.socscimed.2017.03.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 03/02/2017] [Accepted: 03/18/2017] [Indexed: 01/13/2023]
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