School of Public Health, University College Cork, Cork, Ireland
School of Public Health, University College Cork, Cork, Ireland.
BMJ Qual Saf. 2019 Jun;28(6):438-448. doi: 10.1136/bmjqs-2018-008002. Epub 2018 Oct 12.
Many emergency admissions are deemed to be potentially avoidable in a well-performing health system.
To measure the impact of population and health system factors on county-level variation in potentially avoidable emergency admissions in Ireland over the period 2014-2016.
Admissions data were used to calculate 2014-2016 age-adjusted emergency admission rates for selected conditions by county of residence. Negative binomial regression was used to identify which a priori factors were significantly associated with emergency admissions for these conditions and whether these factors were also associated with total/other emergency admissions. Standardised incidence rate ratios (IRRs) associated with a 1 SD change in risk factors were reported.
Nationally, potentially avoidable emergency admissions for the period 2014-2016 (266 395) accounted for 22% of all emergency admissions. Of the population factors, a 1 SD change in the county-level unemployment rate was associated with a 24% higher rate of potentially avoidable emergency admissions (IRR: 1.24; 95% CI 1.04 to 1.41). Significant health system factors included emergency admissions with length of stay equal to 1 day (IRR: 1.20; 95% CI 1.11 to 1.30) and private health insurance coverage (IRR: 0.92; 95% CI 0.89 to 0.96). The full model accounted for 50% of unexplained variation in potentially avoidable emergency admissions in each county. Similar results were found across total/other emergency admissions.
The results suggest potentially avoidable emergency admissions and total/other emergency admissions are primarily driven by socioeconomic conditions, hospital admission policy and private health insurance coverage. The distinction between potentially avoidable and all other emergency admissions may not be as useful as previously believed when attempting to identify the causes of regional variation in emergency admission rates.
在运行良好的医疗体系中，许多急诊入院被认为是可以避免的。
衡量人口和卫生系统因素对爱尔兰 2014-2016 年县级潜在可避免急诊入院变化的影响。
使用入院数据按居住县计算了选定疾病的 2014-2016 年年龄调整后急诊入院率。使用负二项回归确定了哪些先验因素与这些疾病的急诊入院显著相关，以及这些因素是否也与总/其他急诊入院相关。报告了与风险因素 1 SD 变化相关的标准化发病率比 (IRR)。
全国范围内，2014-2016 年期间（266395 例）潜在可避免的急诊入院占所有急诊入院的 22%。在人口因素方面，县级失业率每增加 1 SD，潜在可避免的急诊入院率就会增加 24%（IRR：1.24；95%CI 1.04 至 1.41）。显著的卫生系统因素包括住院时间等于 1 天的急诊入院（IRR：1.20；95%CI 1.11 至 1.30）和私人医疗保险覆盖（IRR：0.92；95%CI 0.89 至 0.96）。全模型解释了每个县潜在可避免的急诊入院中 50%的无法解释的变异。在总/其他急诊入院中也发现了类似的结果。
结果表明，潜在可避免的急诊入院和总/其他急诊入院主要受社会经济条件、住院政策和私人医疗保险覆盖的驱动。在试图确定急诊入院率的区域差异的原因时，潜在可避免和所有其他急诊入院之间的区别可能不像以前认为的那样有用。
