Geographic Variations in Avoidable Hospitalizations in the Elderly, in a Health System with Universal Coverage

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2008 Feb 20

PMID 18282282

Citations 27

Authors

Purificacion Magan

Angel Otero

Angel Alberquilla

Jose Manuel Ribera

Affiliations

Soon will be listed here.

Abstract

Background: The study of Hospitalizations for ambulatory care sensitive conditions (ACSH) has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM) and to detect possible differences in ACSH.

Methods: Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts.

Results: Of all the hospitalizations, 16.5% (64,409) were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p < 0.05) in each district. For men the range was 70.82 and the coefficient of variation (CV) was 0.47, while for women the range was 43.69 and the CV was 0.48. In 93.1% of cases, the ACSH were caused by hypertensive cardiovascular disease, heart failure or pneumonia. A centripetal pattern can be observed, with lower rates in the districts in the center of the CM. This geographic distribution is maintained after grouping by sex.

Conclusion: A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.

Citing Articles

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References

Macintyre S, Hunt K, Sweeting H . Gender differences in health: are things really as simple as they seem?. Soc Sci Med. 1996; 42(4):617-24. DOI: 10.1016/0277-9536(95)00335-5. View

Billings J, Teicholz N . Uninsured patients in District of Columbia hospitals. Health Aff (Millwood). 1990; 9(4):158-65. DOI: 10.1377/hlthaff.9.4.158. View

Zeng F, OLeary J, Sloss E, Lopez M, Dhanani N, Melnick G . The effect of medicare health maintenance organizations on hospitalization rates for ambulatory care-sensitive conditions. Med Care. 2006; 44(10):900-7. DOI: 10.1097/01.mlr.0000220699.58684.68. View

Gaskin D, Hoffman C . Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev. 2000; 57 Suppl 1:85-107. DOI: 10.1177/1077558700057001S05. View

Homar J, Starfield B, Sanchez Ruiz E, Hermosilla Perez E, Mateo M . [Primary health care and hospitalizations in ambulatory care sensitive conditions in Catalonia]. Rev Clin Esp. 2001; 201(9):501-7. DOI: 10.1016/s0014-2565(01)70896-x. View

Giuffrida A, Gravelle H, Roland M . Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes. BMJ. 1999; 319(7202):94-8. PMC: 28159. DOI: 10.1136/bmj.319.7202.94. View

Jankowski R . What do hospital admission rates say about primary care?. BMJ. 1999; 319(7202):67-8. PMC: 1116220. DOI: 10.1136/bmj.319.7202.67. View

Bindman A, Grumbach K, Osmond D, Komaromy M, Vranizan K, Lurie N . Preventable hospitalizations and access to health care. JAMA. 1995; 274(4):305-11. View

Billings J, Zeitel L, Lukomnik J, Carey T, Blank A, Newman L . Impact of socioeconomic status on hospital use in New York City. Health Aff (Millwood). 1993; 12(1):162-73. DOI: 10.1377/hlthaff.12.1.162. View

10.

Laditka J, Laditka S . Insurance status and access to primary health care:disparate outcomes for potentially preventable hospitalization. J Health Soc Policy. 2005; 19(2):81-100. DOI: 10.1300/J045v19n02_04. View

11.

Wolff J, Starfield B, Anderson G . Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002; 162(20):2269-76. DOI: 10.1001/archinte.162.20.2269. View

12.

Pappas G, Hadden W, Kozak L, FISHER G . Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups. Am J Public Health. 1997; 87(5):811-6. PMC: 1381055. DOI: 10.2105/ajph.87.5.811. View

13.

Laditka J, Laditka S . Increased hospitalization risk for recently widowed older women and protective effects of social contacts. J Women Aging. 2003; 15(2-3):7-28. DOI: 10.1300/J074v15n02_02. View

14.

McPherson K, WENNBERG J, Hovind O, Clifford P . Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982; 307(21):1310-4. DOI: 10.1056/NEJM198211183072104. View

15.

Diehr P, Cain K, Ye Z . Small area variation analysis. Methods for comparing several diagnosis-related groups. Med Care. 1993; 31(5 Suppl):YS45-53. View

16.

Santamera A, Franco Vidal A, Redondo Martin S, Garcia De Duenas Geli L, Rodriguez Gonzalez A . [Hospitalization rates in infants aged less than 1 year in Madrid and their relationship with socioeconomic indicators and infant mortality]. An Esp Pediatr. 2002; 57(3):220-6. View

17.

Ansari Z, Laditka J, Laditka S . Access to health care and hospitalization for ambulatory care sensitive conditions. Med Care Res Rev. 2006; 63(6):719-41. DOI: 10.1177/1077558706293637. View

18.

Kozak L, Hall M, Owings M . Trends in avoidable hospitalizations, 1980-1998. Health Aff (Millwood). 2001; 20(2):225-32. DOI: 10.1377/hlthaff.20.2.225. View

19.

Laditka J, Laditka S, Mastanduno M . Hospital utilization for ambulatory care sensitive conditions: health outcome disparities associated with race and ethnicity. Soc Sci Med. 2003; 57(8):1429-41. DOI: 10.1016/s0277-9536(02)00539-7. View

20.

Zhang W, Mueller K, Chen L, Conway K . The role of rural health clinics in hospitalization due to ambulatory care sensitive conditions: a study in Nebraska. J Rural Health. 2006; 22(3):220-3. DOI: 10.1111/j.1748-0361.2006.00035.x. View