Harriss Linton R, Thompson Fintan, Lawson Kenny, O'Loughlin Mary, McDermott Robyn
Aust Health Rev. 2019 Aug;43(4):483. doi: 10.1071/AH18033_CO.
The aims of this study were to: (1) use local health data to examine potentially preventable hospitalisations (PPHs) as a proportion of total hospital separations and estimated costs to a large regional hospital in northern Queensland, including differences associated with Indigenous status; and (2) identify priority conditions and discuss issues related to strategic local primary health intervention. A cross-sectional analysis was conducted using Queensland Hospital Admitted Patient Data Collection data (July 2012-June 2014) restricted to 51087 separations generated by 29485 local residents. PPHs were identified from the International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification (ICD-10-AM) and procedure codes using National Healthcare Agreement definitions. Age-standardised separation rates were calculated using Australian 2001 reference population and associated economic costs were estimated using Australian-refined diagnosis related groups. Eleven per cent (n=5488) of all hospital separations were classified as PPH, and most were for common chronic (n=2486; 45.3%) and acute (n=2845; 51.8%) conditions. Because many acute presentations reflect chronic underlying disease, chronic conditions account for up to 76.5% of all PPHs. Age-standardised PPH rates were 3.4-fold higher for Indigenous than non-Indigenous people. Associated 2-year costs were AU$32.7million, which was 10.7% of estimated total health care expenditure for hospital separations, and were higher for Indigenous (14.9%) than non-Indigenous (9.7%) people. High hospitalisation rates and costs for common preventable chronic conditions represent opportunities for primary healthcare interventions. In particular, community-level health services need to be more responsive to the needs of local Indigenous families. PPH rates are used as a measure of timely access to quality primary health care, and are incrementally higher in regional and remote areas than in major cities. Investment in primary healthcare services has been shown to significantly reduce costs associated with avoidable hospitalisations. This study used local health data to identify the most common PPH conditions presenting to a large regional hospital in northern Queensland, including estimation of costs and differences associated with Indigenous status. Recommendations are made to strengthen primary healthcare and reduce hospital-related costs. Interventions to address high PPH rates should be tailored to meet the needs of the local population. Primary health strategies targeting common chronic conditions provide the greatest opportunity to reduce avoidable hospitalisations and costs in this regional area. Investment in collaborative, evidence-based interventions is recommended and justified, especially for Indigenous Australians.
(1)利用当地健康数据,调查在昆士兰州北部一家大型地区医院中,潜在可预防住院(PPH)占总出院人数的比例以及估计成本,包括与原住民身份相关的差异;(2)确定优先疾病,并讨论与当地初级卫生战略干预相关的问题。使用昆士兰医院住院患者数据收集数据(2012年7月至2014年6月)进行横断面分析,该数据仅限于29485名当地居民产生的51087次出院。根据《国际疾病和相关健康问题统计分类第10次修订澳大利亚版》(ICD - 10 - AM)和程序代码,采用国家医疗保健协议定义来确定PPH。使用澳大利亚2001年参考人群计算年龄标准化出院率,并使用澳大利亚细化的诊断相关组估计相关经济成本。所有出院病例中有11%(n = 5488)被归类为PPH,大多数是常见的慢性疾病(n = 2486;45.3%)和急性疾病(n = 2845;51.8%)。由于许多急性病症反映了潜在的慢性疾病,慢性病在所有PPH中占比高达76.5%。原住民的年龄标准化PPH率是非原住民的3.4倍。相关的两年成本为3270万澳元,占出院估计总医疗支出的10.7%,原住民(14.9%)高于非原住民(9.7%)。常见可预防慢性病的高住院率和成本代表了初级卫生保健干预的机会。特别是,社区层面的卫生服务需要更能响应当地原住民家庭的需求。PPH率被用作衡量及时获得优质初级卫生保健的指标,并且在地区和偏远地区比在大城市中逐渐更高。对初级卫生保健服务的投资已被证明能显著降低与可避免住院相关的成本。本研究利用当地健康数据确定了昆士兰州北部一家大型地区医院出现的最常见PPH病症,包括成本估计以及与原住民身份相关的差异。提出了加强初级卫生保健和降低与医院相关成本的建议。应对高PPH率的干预措施应根据当地人群的需求进行调整。针对常见慢性病的初级卫生战略为减少该地区可避免的住院和成本提供了最大机会。建议并证明对基于证据的协作性干预措施进行投资是合理的,特别是针对澳大利亚原住民。