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Abstract
Background Many emergency admissions are deemed to be potentially avoidable in a well-performing health system.
Objective 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.
Methods 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.
Results 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.
Conclusion 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.
- health services research
- ambulatory care
- emergency department
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Footnotes
Contributors All authors (BL, APF, PC, OH, CB and JB) made substantial contributions to the conception and design of this article. BL contributed to the acquisition of data. BL and APF contributed to the analysis of data. BL, APF, PC and JB contributed to the interpretation of data. BL, APF and JB drafted the article. PC, OH, and CB revised the article critically for important intellectual content. All authors gave final approval of the version submitted. All authors agree to be accountable for all aspects of the work in ensuring that questions related to accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding Funding was received from the Health Research Board (HRB), 'Funding University College Cork Collaborative Applied Research Grant 2012' (CARG/2012/28).
Competing interests OH is a member of the Reconfiguration Forum for Cork and Kerry (having been a member of the Project Team 2008–2011) and is currently seconded to the Department of Health as part of the National Establishment of Hospital Groups project team.
Patient consent Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data sets studied during the current study are not publicly available due to confidentiality agreements made with both the CSO and HIPE regarding potential identifiability of data analysed. Aggregated levels of the data may be available from the corresponding author on reasonable request.