Potentially preventable emergency hospital admissions

It is possible to reduce unnecessary hospital admissions for patients with certain conditions by providing them with good quality preventive and primary care. These conditions are known as ambulatory care-sensitive (ACS) conditions.

Has the number of ACS admissions increased over time?

ACS admission can be defined on the basis of the most important (primary) diagnosis or as one of the many possible secondary diagnoses. Between 2001/02 and 2013/14 the annual number of emergency admissions for ACS conditions increased by 48%, rising from 704,153 to 1,039,242 – an increase of 335,089. Over the same time period emergency admissions for non-ACS conditions increased by only 34%, meaning that the proportion of all emergency admissions that were ACS increased from 18% in 2001/02 to 20% in 2013/14.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics (Copyright 2013, Re-used with the permission of the Health & Social Care Information Centre. All rights reserved)

Did all types of ACS condition show the same trend over time?

When ACS admissions are categorised as acute, chronic or other and vaccine preventable, it is evident these groups changed at different rates. The rate of emergency admissions for acute ACS conditions increased by 48%, from 486 admissions per 100,000 population in 2001/02 to 718 in 2013/14. The increase in the other and vaccine preventable category of admissions was even greater (142%), but from a much lower base (81 in 2001/02 to 197 in 2013/14). Rates of admission for chronic ACS conditions remained relatively stable over time (710 in 2001/02, 668 in 2013/14, a decrease of 6%). These latter changes are a positive sign of potential improvements in the management of chronic disease.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics (Copyright 2013, Re-used with the permission of the Health & Social Care Information Centre. All rights reserved)

What was the trend for conditions with the biggest changes over time?

Looking at the individual conditions it seems that rates of emergency admission for angina had nearly halved since 2001/02, and admissions for congestive heart failure were down by one-quarter. However, the net saving of 110 admissions per 100,000 a year was outweighed by the increase in UTI/pyelonephritis alone (an extra 134 annual admissions per 100,000 since 2001/02). While changes in rates of admission for asthma were not statistically significant, the volume of admissions was so large that it was among the three largest decreases in rate.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics (Copyright 2013, Re-used with the permission of the Health & Social Care Information Centre. All rights reserved)

Did rates of ACS admission show greater increases in more deprived areas?

Admission rates were much higher in the more deprived populations – a pattern that was consistent over time (back to 2001/02). The admission rate in the most deprived twentieth of the population (vigintile) increased from 2,362 admissions per 100,000 to 2,926, while that for the least deprived vigintile increased from 758 to 922. Rates of admission for people living in deprived areas have increased more than those living in less deprived areas (564 extra admissions per 100,000 in the most deprived vigintile, compared with 164 in the least deprived). Yet the percentage increase was similar (22% compared with 24%), and the relative difference between the most and least deprived remained almost constant over the period.

Source: 
Health & Social Care Information Centre, Hospital Episode Statistics (Copyright 2013, Re-used with the permission of the Health & Social Care Information Centre. All rights reserved)

How do the rates of COPD and asthma admissions compare internationally over time?

Overall, COPD-related hospital admissions are more common than asthma- or diabetes-related hospital admissions.

When comparing the UK with other countries, for both COPD and asthma the age-standardised rate per 100,000 population is relatively high; for asthma, the UK is one of the worst performers of all the comparator countries. However, there has been a reduction in the number of hospital admissions for COPD and asthma in the UK in recent years. For COPD, there was an 11 per cent reduction between 2006 and 2011 (from 254.4 admissions per 100,000 population in 2006 to 226.5 admissions per 100,000 population in 2011). For asthma, the rate dropped by 24 per cent between 2006 and 2011 (from 79.5 admissions per 100,000 population to 60.8 admissions per 100,000 population). This decline in the number of hospital admissions may reflect some improvement in the quality of care provided for these conditions.

Trends in the other countries under analysis in this report vary. For example, there has been a continuous sharp decline in Italy in the number of hospital admissions for COPD and in Ireland in the number of hospital admissions for asthma. In the other countries, trends are more stable. Of all the OECD countries, Japan has the lowest admission rate for COPD and Italy has the lowest rate for asthma. Trends in the UK seen in the OECD data reported here are broadly consistent with those reported in earlier work on adult hospital admissions for ambulatory care sensitive conditions in England (Blunt, 2013).

While the focus in this analysis is not on respiratory deaths, it is worth noting that the recently published inquiry by the All Party Parliamentary Group on Respiratory Health (2014) into respiratory deaths concluded that the quality of services and outcomes in the UK compared very poorly with other countries and that urgent action was needed. The inquiry report highlights that awareness in the population as well as among non-specialist professionals, and the effective implementation of numerous, existing, evidence-based clinical guidelines, should be the priority in order to prevent potentially unnecessary admissions and deaths. Other reports have highlighted concern in the quality of care provided to asthma and COPD patients (Department of Health, 2012; Healthcare Quality Improvement Partnership, 2014b).

Last updated: July 2015.

Source: 

Organisation for Economic Co-operation and Development, Health Data

How does the rate of diabetes admissions compare internationally over time?

Diabetes is a common chronic condition for which inadequate management can lead to a range of short-term (eg, diabetic coma) and long-term (eg, cardiovascular disease, retinopathy and kidney disease) complications. The hospital admission rate in the UK for short- and long-term diabetes complications and uncontrolled diabetes without complications has been stable since 2006, with approximately 73 admissions per 100,000 population in 2011 – one of the lowest rates among the comparator countries.

Both Italy and the Netherlands had lower rates of admission than the UK, with France having the lowest. Despite lower hospital admissions, the estimated prevalence of diabetes in 2014 was higher in France (7.17%) than in the UK (5.38%) (International Diabetes Federation, 2014). Ideally, we would like to measure hospital admissions within the diabetes population rather than the general population. While hospital admission rates have been stable in the UK, many adults but especially children still do not receive the recommended care for diabetes (Health and Social Care Information Centre, 2014; Royal College of Paediatrics and Child Health, 2015) and there are large variations around Europe in the quality of care provided and diabetes outcomes (e.g. HbA1c control) (see the SWEET project).

Last updated: July 2015. 

Source: 

Organisation for Economic Co-operation and Development, Health Data

How does the rate of diabetes lower extremity amputations admissions compare internationally over time?

Looking at the more specific indicator of hospital admission rates for diabetes lower extremity amputations, these have also been stable in the UK since 2006 – at an average of five amputations per 100,000 population. In many of the other countries under analysis, the rate has also been stable. The UK’s performance relative to other countries appears good. However, Sweden had only 3.3 amputations per 100,000 population in 2011 (the estimated diabetes prevalence in 2014 was 6.14 per cent), while Hungary had only 0.7 amputations per 100,000 population in 2012 (the estimated diabetes prevalence in 2014 was 7.51 per cent). Other evidence from England suggests that many of the amputations could still be prevented with targeted preventative services and fast access to high-quality foot care (Kerr, 2012). Also, multidisciplinary diabetic foot care teams improve outcomes and reduce costs to the NHS (Kerr, 2012).

It is important to be mindful of the differences in coding practices (e.g. major/minor amputations) that are likely to have an impact on the observed differences between countries. OECD and country experts are working on further improving the quality of the diabetes data.

Last updated: July 2015. 

Source: 

Organisation for Economic Co-operation and Development, Health Data

About this data

There are many different definitions of which conditions should be considered as ACS. The definitions used here are listed in the online appendix to our Focus on preventable admissions report. For a discussion of the various ways of defining an ACS admission, see Purdy and others (2009).

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