Santos Rita, Rice Nigel, Gravelle Hugh
Centre for Health Economics, University of York, York, North Yorkshire, UK
Centre for Health Economics, University of York, York, North Yorkshire, UK.
BMJ Open. 2020 Nov 4;10(11):e039910. doi: 10.1136/bmjopen-2020-039910.
To examine the spatial and temporal patterns of English general practices' emergency admissions for Ambulatory Care Sensitive Conditions (ACSCs).
Observational study of practice level annual hospital emergency admissions data for ACSCs for all English practices from 2004-2017.
All patients with an emergency admission to a National Health Service hospital in England who were registered with an English general practice.
Practice level age and gender indirectly standardised ratios (ISARs) for emergency admissions for ACSC.
In 2017, 41.8% of the total variation in ISARs across practices was the 207 Clinical Commissioning Groups (CCGs) (the administrative unit for general practices) and 58.2% was practices within CCGs. ACSC ISARs increased by 4.7% between 2004 and 2017, while those for conditions incentivised by the Quality and Outcomes Framework (QOF) fell by 20%. Practice ISARs are persistent: practices with high rates in 2004 also had high rates in 2017. Standardising by deprivation as well as age and gender reduced the coefficient of variation of practice ISARs in 2017 by 22%.
There is persistent spatial pattern of emergency admissions for ACSC across England both within and across CCGs. We illustrate the reduction in ACSCs emergency admissions across the study period for conditions incentivised by the QOF but find that this was not accompanied by a reduction in variation in these admissions across practices. The observed spatial pattern persists when admission rates are standardised by deprivation. The persistence of spatial clusters of high emergency admissions for ACSCs within and across CCG boundaries suggests that policies to reduce potentially unwarranted variation should be targeted at practice level.
研究英格兰全科医疗中门诊医疗敏感疾病（ACSCs）紧急入院的时空模式。
对2004年至2017年所有英格兰全科医疗的ACSCs年度医院紧急入院数据进行实践水平观察性研究。
所有在英格兰国家医疗服务体系医院紧急入院且在英格兰全科医疗注册的患者。
ACSC紧急入院的实践水平年龄和性别间接标准化比率（ISARs）。
2017年，各实践中ISARs总变异的41.8%归因于207个临床委托小组（CCGs，全科医疗的行政单位），58.2%归因于CCGs内的实践。2004年至2017年，ACSC的ISARs上升了4.7%，而质量与结果框架（QOF）激励的疾病的ISARs下降了20%。实践ISARs具有持续性：2004年比率高的实践在2017年比率也高。按贫困程度以及年龄和性别进行标准化后，2017年实践ISARs的变异系数降低了22%。
在英格兰，CCGs内部和之间都存在ACSC紧急入院的持续空间模式。我们说明了在研究期间，QOF激励的疾病的ACSCs紧急入院有所减少，但发现这些入院情况在各实践中的变异并未随之减少。当按贫困程度对入院率进行标准化时，观察到的空间模式仍然存在。CCGs边界内和之间ACSCs高紧急入院空间集群的持续性表明，减少潜在不必要变异的政策应针对实践层面。
