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© Nuffield Trust and Health Foundation © Nuffield Trust
23 October 2013
Focus on…
© Nuffield Trust and Health Foundation
Focus on: a series of in-depth reports
Each year the programme will produce a number of in-depth analyses into specific topics in health and social care using a range of methods.
• Accessibility of acute services
• Trends in preventable emergency admissions
• Analysis of patterns of antidepressant prescribing during the recession
• Access to social care for older people
• Changes in quality for people with hip fractures
© Nuffield Trust and Health Foundation © Nuffield Trust
23 October 2013
Focus on preventable admissions
Ian Blunt
© Nuffield Trust and Health Foundation
A way of categorising “preventable” admissions?
• For certain conditions, the risk of a crisis leading to emergency hospital admission can be reduced by timely and effective self-care, primary or community care
• A subset of these conditions has been identified as potential indicators of how well health services are managing care to avoid the problems that require emergency admissions.
• This technique for quality measurement was developed in the USA in the early 1990s – now in many countries, including NHS Outcomes Framework
© Nuffield Trust and Health Foundation
Analytical approach
• Hospital Episode Statistics data
from 2001 to 2013
• Valid age, sex and English LSOA
• Victoria State Health Department
list of ACS conditions +
tuberculosis
• Age/sex–specific admission rates
using ONS population estimates
• Deprivation measured by Indices of
Multiple Deprivation 2010
© Nuffield Trust and Health Foundation
The conditions matter
“ACS” often used as an aggregate term, but no standard definition (Purdy 2009)
Which conditions are included can make a big difference -chronic ACS admissions in Chichester, for example…
0
100
200
300
400
500
600
700
800
2001/0
2
2002/0
3
2003/0
4
2004/0
5
2005/0
6
2006/0
7
2007/0
8
2008/0
9
2009/1
0
2010/1
1
2011/1
2
2012/1
3
Indir
ectly s
tandard
ised r
ate
(IS
R)
per
100,0
00 p
opula
tion
QualityWatch NHS OF 2.3i
© Nuffield Trust and Health Foundation
© Nuffield Trust and Health Foundation
The influence of deprivation
© Nuffield Trust and Health Foundation
Variation in 2012/13
© Nuffield Trust and Health Foundation
Variation by condition in 2012/13
© Nuffield Trust and Health Foundation
Large but uneven increases since 2001
© Nuffield Trust and Health Foundation
Increases swamp reductions…
© Nuffield Trust and Health Foundation
Change relative to financial constraints
© Nuffield Trust and Health Foundation
Conclusion
• Importance of understanding rate and trend for each condition at local level
• Deprivation an important factor to consider – but leave much variation unexplained
• Rates of admission for some conditions have reduced, but many more have increased (including some where substantial policy effort has been applied)
• General trends are being maintained, so far…
© Nuffield Trust and Health Foundation
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23 October 2013
www.qualitywatch.org.uk