Wide systematic variations in potentially avoidable hospitalizations of chronically ill patients: Ecological study of primary care areas and healthcare areas

Abstract

Background and objective: Potentially avoidable hospitalisations (PAHs) due to chronic conditions are a healthcare problem that could reflect healthcare of insufficient quality. This study reports the systematic variations in PAHs for the collection of providers of the Spanish National Health System.

Materials and methods: We conducted an ecological study on government data, analysing the systematic variation in PAHs for 6 chronic conditions during 2013-2015. To determine the variation, we performed a small area analysis using Bayesian methodology.

Results: Between 2013 and 2015, 439,878 admissions for PAHs were recorded in the Spanish National Health System. There was an up to 4-fold difference in PAH rates between certain basic health areas (BHA), with highly variable differences depending on the analyzed condition. Forty percent of the BHAs showed a greater than expected risk of PAH. Beyond the systematic variation observed between BHAs, the healthcare areas of the patients' residence explained 33% of the variation in PAHs. We observed specific differences in these general results according to clinical condition, age and sex.

Conclusions: The wide systematic variation in PAHs suggests a problem of quality in the care provided to chronically ill patients by the providers of healthcare areas in Spain. Identifying and analysing these areas and other healthcare areas with better results could provide a reference for improving the care of other suppliers with poorer performance.

Keywords: Accesibilidad a servicios sanitarios; Ambulatory care-sensitive conditions; Análisis de área pequeña; Chronic disease; Condiciones sensibles a cuidados ambulatorios; Continuidad de ciudados; Continuity of patient care; Enfermedad crónica; Health services accessibility; Small Area analysis.