Characteristics of general practices associated with emergency admission rates to hospital: a cross-sectional study
Open Access
- 22 April 2011
- journal article
- research article
- Published by BMJ in Emergency Medicine Journal
- Vol. 28 (7), 558-563
- https://doi.org/10.1136/emj.2010.108548
Abstract
Objectives To identify characteristics of general practices associated with emergency hospital admission rates, and determine whether levels of performance and patient reports of access are associated with admission rates. Design A cross-sectional study. Setting Two primary care trusts (Leicester City and Leicestershire County and Rutland) in the East Midlands of England. Participants 145 general practices. Methods Hospital admission data were used to calculate the rate of emergency admissions from 145 practices, for two consecutive years (2006/7 and 2007/8). Practice characteristics (size, distance from principal hospital, quality and outcomes framework performance data, patient reports of access to their practices) and patient characteristics (deprivation, ethnicity, gender and age), were used as predictors in a two-level hierarchical model, developed with data for 2007/8, and evaluated against data for 2006/7. Results Practice characteristics (shorter distance from hospital, smaller list size) and patient characteristics (higher proportion of older people, white ethnicity, increasing deprivation, female gender) were associated with higher admission rates. There was no association with quality and outcomes framework domains (clinical or organisation), but there was an association between patients reporting being able to see a particular general practitioner (GP) and admission rates. As the proportion of patients able to consult a particular GP increased, emergency admission rates declined. Conclusions The patient characteristics of deprivation, age, ethnicity and gender are important predictors of admission rates. Larger practices and greater distance from a hospital have lower admission rates. Being able to consult a particular GP, an aspect of continuity, is associated with lower emergency admission rates.Keywords
This publication has 13 references indexed in Scilit:
- General practice size determines participation in optional activities: cross-sectional analysis of a national primary care systemPrimary Health Care Research & Development, 2010
- Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in EnglandBMJ, 2009
- Effects of Pay for Performance on the Quality of Primary Care in EnglandNew England Journal of Medicine, 2009
- Out-of-hours care in western countries: assessment of different organizational modelsBMC Health Services Research, 2009
- Quality of Primary Care and Hospital Admissions for Diabetes Mellitus in EnglandThe Journal of Ambulatory Care Management, 2008
- Do patients value continuity of care in general practice? An investigation using stated preference discrete choice experimentsJournal of Health Services Research & Policy, 2007
- Association of population and practice factors with potentially avoidable admission rates for chronic diseases in London: cross sectional analysisJournal of the Royal Society of Medicine, 2006
- The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?American Journal of Public Health, 1998
- Hospital admissions for asthma in east london: associations with characteristics of local general practices, prescribing, and populationBMJ, 1997