Health Organisation, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, 5292The University of Manchester, UK.
Melbourne Institute: Applied Economic and Social Research, 5292University of Melbourne, Australia.
J Health Serv Res Policy. 2022 Jul;27(3):232-241. doi: 10.1177/13558196211059128. Epub 2022 Feb 6.
Admissions for ambulatory care sensitive conditions (ACSCs) are often used to measure potentially preventable emergency care. Visits to emergency departments with ACSCs may also be preventable care but are excluded from such measures if patients are not admitted. We established the extent and composition of this preventable emergency care.
We analysed 1,505,979 emergency department visits (5% of the national total) between 1 April 2015 and 31 March 2017 at six hospital Trusts in England, using International Classification of Diseases diagnostic coding. We calculated the number of visits for each ACSC and examined the proportions of these visits that did not result in admission by condition and patient characteristics.
11.1% of emergency department visits were for ACSCs. 55.0% of these visits did not result in hospital admission. Whilst the majority of ACSC visits were for acute rather than chronic conditions (59.4% versus 38.4%), acute visits were much more likely to conclude without admission (70.3% versus 33.4%). Younger, more deprived and ethnic minority patients were less likely to be admitted when they visited the emergency department with an ACSC.
Over half of preventable emergency care is not captured by measures of admissions. The probability of admission at a preventable visit varies substantially between conditions and patient groups. Focussing only on admissions for ACSCs provides an incomplete and skewed picture of the types of conditions and patients receiving preventable care. Measures of preventable emergency care should include visits in addition to admissions.
门诊医疗敏感条件（ACSCs）的入院率通常用于衡量潜在可预防的急诊护理。如果患者未住院，急诊科 ACSC 就诊也可能属于可预防的医疗护理，但这些措施并未将其包括在内。我们确定了这种可预防的急诊护理的程度和构成。
我们分析了 2015 年 4 月 1 日至 2017 年 3 月 31 日期间英格兰六个医院信托的 1505979 例急诊部就诊（占全国总数的 5%），使用国际疾病分类诊断编码。我们计算了每种 ACSC 的就诊次数，并按条件和患者特征检查了这些就诊中未导致入院的比例。
11.1%的急诊就诊是 ACSC。这些就诊中有 55.0%未导致住院。虽然大多数 ACSC 就诊是急性而不是慢性疾病（59.4%对 38.4%），但急性就诊更不可能在没有入院的情况下结束（70.3%对 33.4%）。当 ACSC 患者到急诊就诊时，年龄较小、贫困程度较高和少数民族患者入院的可能性较低。
超过一半的可预防急诊护理未被入院率衡量所涵盖。在可预防就诊中，入院的可能性在不同条件和患者群体之间有很大差异。仅关注 ACSC 的入院情况，会提供一种不完整和有偏差的条件和患者接受可预防护理的情况。可预防急诊护理的衡量标准应包括就诊，而不仅仅是入院。
