Potentially preventable emergency hospital admissions
Unplanned hospital admissions are both costly and frequently unpleasant experiences for patients. Many hospital admissions related to long-term conditions could be avoided, if timely and effective care is provided to the patient in the community. These conditions are known as ambulatory care-sensitive (ACS) conditions. Here we look at admission for all ACS conditions in England, and three common chronic conditions - chronic obstructive pulmonary disease (COPD), asthma and diabetes - internationally.
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).
Definitions and comparability for the international indicators are taken directly from the OECD reportHealth at a Glance 2017: OECD indicators. Detailed information about the definitions and the source and methods for each country can be found here.
The asthma and COPD indicators are defined as the number of hospital admissions with a primary diagnosis of asthma or COPD among people aged 15 years and over per 100,000 population. Rates are age-sex standardised to the 2010 OECD population aged 15 and over. Admissions resulting from a transfer from another hospital and where the patient dies during the admission are excluded from the calculation as these admissions are considered unlikely to be avoidable.
Diabetes avoidable admission is based on the sum of three indicators: admissions for short-term and long-term complications and for uncontrolled diabetes without complications. The indicator is defined as the number of hospital admissions with a primary diagnosis of diabetes among people aged 15 years and over per 100,000 population. Rates were directly age-sex standardised to the 2010 OECD population.
Differences in data definition and coding practices between countries may affect the comparability of data. For example, coding of diabetes as a principal diagnosis versus a secondary diagnosis varies across countries. This is more pronounced for diabetes than other conditions, given that in many cases admission is for the secondary complications of diabetes rather than diabetes itself.
One of the main problems with these indicators is that they look only at hospital admissions and do not take account of differences in disease prevalence. For example, with regard to diabetes, it is not clear whether lower admission rates are due to a lower prevalence of diabetes in the population or better management of people with diabetes.