Silwal Pushkar Raj, Exeter Daniel, Tenbensel Tim, Lee Arier
Health Systems Department, The University of Auckland, Auckland, New Zealand
Section of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand.
BMJ Open. 2022 Jun 1;12(6):e052209. doi: 10.1136/bmjopen-2021-052209.
To investigate interdistrict variations in childhood ambulatory sensitive hospitalisation (ASH) over the years.
Observational population-based study over 2008-2018 using the Primary Health Organisation Enrolment Collection (PHO) and the National Minimum Dataset hospital events databases.
New Zealand primary and secondary care.
All children aged 0-4 years enrolled in the PHO Enrolment Collection from 2008 to 2018.
ASH.
Only 1.4% of the variability in the risk of having childhood ASH (intracluster correlation coefficient=0.014) is explained at the level of District Health Board (DHB), with the median OR of 1.23. No consistent time trend was observed for the adjusted childhood ASH at the national level, but the DHBs demonstrated different trajectories over the years. Ethnicity (being a Pacific child) followed by deprivation demonstrated stronger relationships with childhood ASH than the geography and the health system input variables.
The variation in childhood ASH is explained only minimal at the DHB level. The sociodemographic variables also only partly explained the variations. Unlike the general ASH measure, the childhood ASH used in this analysis provides insights into the acute conditions sensitive to primary care services. However, further information would be required to conclude this as the DHB-level performance variations.
调查多年来儿童门诊敏感住院（ASH）的地区间差异。
基于人群的观察性研究，利用初级卫生组织注册登记数据（PHO）和国家最低数据集医院事件数据库，研究时间跨度为2008年至2018年。
新西兰的初级和二级医疗保健。
2008年至2018年在PHO注册登记的所有0至4岁儿童。
ASH。
在地区卫生委员会（DHB）层面，仅有1.4%的儿童ASH风险变异性（组内相关系数=0.014）可得到解释，中位数比值比为1.23。在国家层面，未观察到调整后的儿童ASH有一致的时间趋势，但各DHB在多年间呈现出不同的轨迹。种族（太平洋岛民儿童）和贫困程度与儿童ASH的关联，比地理位置和卫生系统投入变量更强。
儿童ASH的差异在DHB层面仅有极小部分可得到解释。社会人口学变量也仅部分解释了这些差异。与一般的ASH指标不同，本分析中使用的儿童ASH指标能洞察对初级保健服务敏感的急性病症。然而，要得出这是DHB层面的绩效差异，还需要更多信息。
